Peripheral artery disease in patients with acute coronary syndrome without ST-segment elevation: impact on therapy and prognosis
Authors: Carias M , Paralta M , Almeida A , Claudio F , Rocha R , Picarra B , Bento A , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Peripheral artery disease (PAD) is an important co-morbidity in non-ST-segment elevation acute coronary syndromes (NSTEMI), and its presence may affect the therapeutic approach and prognosis of these patients.

Purpose
To assess the impact of PAD presence on therapeutic approach, clinical outcome, and in-hospital and 1-year mortality in patients with NSTEMI.

Methods
We studied 7248 patients with NSTEMI included in a national multicenter registry. We considered 2 groups: patients with PAD and patients without PAD. Demographic variables, CV risk factors, inpatient therapy, left ventricular function (LVF), coronary angiography and revascularization strategy performed were recorded. The following in-hospital adverse events (AE) were defined: death, re-infarction, stroke, heart failure (HF), cardiogenic shock (CC), major bleeding (MH), need for blood transfusion (BT). Length of stay (IT) and in-hospital and 1-year mortality were evaluated. Multivariate analysis was performed to assess whether the presence of PAD is a predictor of HAS and/or 1-year mortality.

Results
The presence of PAD was 7.3% (526 patients). These patients were older (70±11 vs 67±13 years, p&lt;0.001), higher prevalence of males (82.1 vs 70.7%, p&lt;0.001), arterial hypertension (87.4 vs 74.1%, p&lt;0.001), diabetes mellitus ( 55.3 vs 32.3%, p&lt;0.001), dyslipidemia (76 vs 61.9%, p&lt;0.001), previous AMI (48.4 vs 24.6%, p&lt;0.001), previous PCI (28.4 vs 17.5%, p&lt;0.001), CABG ( 20.0 vs 6.5%, p&lt;0.001), stroke (25.4 vs 7.5%, p&lt;0.001) and chronic renal failure (22.9 vs 6.3%, p&lt;0.001). Patients with PAD: evolved more frequently in Killip≥II (26.0 vs 13.9%, p&lt;0.001), with LV dysfunction (LVF&lt;50%: 42.7 vs 28.3%, p&lt;0.001) and the need for non-invasive ventilation (3 vs 1.7%, p=0.019). Patients with PAD were less frequently medicated with beta-blockers (75 vs 87.5%, p&lt;0.001) and more frequently with diuretics (47.3 vs 26.6%, p&lt;0.001). Patients with PAD underwent fewer coronary angiograms (69.8 vs 85.6%, p&lt;0.002), but the femoral approach was more used (35.2 vs 21.4%) and had more multivessel disease (76.7 vs 52.4%, p&lt;0.001). Patients with PAD had a longer in-hospital stay duration (median 7 vs 5 days, p&lt;0.001), higher incidence of re-AMI (3.1 vs 1.4%, p=0.003), HF (26.7 vs 12.4%, p=0.002), CC (3.2 vs 1.8%, p=0.016), MH (2.3 vs 1.1%, p=0.001) and BT (4.6 vs 1.6%, p&lt;0.001), but not stroke. In-hospital mortality was higher (4 vs 2%, p=0.003) as well as 1-year mortality (16.2 vs 6.2%, p&lt;0.001). By multivariate analysis, PAD was an independent predictor of 1-year mortality (OR=1.57, 95% CI [1.04-2.58], p=0.032), but not of AE.

Conclusion
The presence of PAD affects the therapy and revascularization strategy in patients with NSTEMI, being associated with higher in-hospital morbidity and mortality. This co-morbidity constitutes an independent predictor of death at 1 year.