Impact of Polyvascular Disease on Long-Term Prognosis of Patients with Acute Coronary Syndrome—A Retrospective Cohort Study in Italy

TL;DR

This study finds that patients with heart attacks who also have disease in other blood vessels face higher long-term risks, especially if multiple areas are affected.

Contribution

The study provides new insights into how polyvascular disease impacts long-term outcomes in acute coronary syndrome patients using a large Italian cohort.

Findings

Polyvascular disease increases the risk of major adverse cardiovascular events in acute coronary syndrome patients.

Patients with disease in both peripheral and cerebral blood vessels face the highest risk of poor long-term outcomes.

Adjusting for age, sex, and comorbidities, the risk increases with the number of affected vascular beds.

Abstract

Background: Atherothrombosis is a systemic disease that may affect one or more than one vascular bed. Data on the impact of polyvascular disease (PVD) on the long-term prognosis of patients with coronary artery disease (CAD) are still scarce. Aim: To assess the prevalence of symptomatic PVD in a cohort of patients with a new episode of acute coronary syndrome (ACS) and to investigate the impact of multiple vascular beds involvement on long-term outcomes. Methods: We analysed a nationwide, comprehensive administrative database of consecutive patients aged ≥ 40 years admitted for a new episode of ACS in Italy in 2017–2018. Patients with ACS were stratified according to the presence of peripheral artery disease (PAD) only; cerebrovascular disease (CeVD) only; PAD+CeVD; or neither (no PAD/noCeVD, i.e., ACS only). A multivariate Cox proportional hazards model was used to assess the impact of PAD only; CeVD only and PAD+CeVD on 5-year MACCE. Results: A total of 342,052 patients hospitalised with ACS were identified. Among them, 24,727 (7.2%) were patients with PAD only, 16,887 (4.9%) with CeVD only, and 5810 (1.7%) with PAD+CeVD. After adjusting for age, sex, and comorbidities, the hazard ratio (HR) for 5-year MACCE was 1.37 (95% CI: 1.35–1.40), 1.36 (95% CI: 1.33–1.39), and 1.45 (95% CI: 1.40–1.50) in patients with PAD only, CeVD only, and PAD+CeVD, respectively, compared with patients with ACS only. Conclusions: In patients with ACS, the involvement of a second vascular bed increases the risk of long-term outcomes; the simultaneous involvement of three vascular beds further increases the risk of long-term outcomes.

Figures