History of peripheral artery disease and cardiovascular risk of real-word patients with acute coronary syndrome: Role of inflammation and comorbidities.

Denegri, Andrea; Magnani, Giulia; Kraler, Simon; Bruno, Francesco; Klingenberg, Roland; Mach, Francois; Gencer, Baris; Räber, Lorenz; Rodondi, Nicolas; Rossi, Valentina A; Matter, Christian M; Nanchen, David; Obeid, Slayman; Lüscher, Thomas F (2023). History of peripheral artery disease and cardiovascular risk of real-word patients with acute coronary syndrome: Role of inflammation and comorbidities. International journal of cardiology, 382, pp. 76-82. Elsevier 10.1016/j.ijcard.2023.03.043

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BACKGROUND

Patients with acute coronary syndromes (ACS) remain at risk of cardiovascular disease (CVD) recurrences. Peripheral artery disease (PAD) may identify a very high risk (VHR) group who may derive greater benefit from intensified secondary prevention.

METHODS

Among ACS-patients enrolled in the prospective multi-center Special Program University Medicine (SPUM), we assessed the impact of PAD on major cardiovascular events (MACE: composite of myocardial infarction, stroke and all-cause death) and major bleeding. Multivariate analysis tested the relation of each significant variable with MACE, as well as biomarkers of inflammation and novel markers of atherogenesis.

RESULTS

Out of 4787 ACS patients, 6.0% (n = 285) had PAD. PAD-patients were older (p < 0.001), with established CVD and signs of increased persistent inflammation (hs-CRP; 23.6 ± 46.5 vs 10.4 ± 27.2 mg/l, p < 0.001 and sFlt-1; 1399.5 ± 1501.3 vs 1047.2 ± 1378.6 ng/l, p = 0.018). In-hospital-death (3.2% vs 1.4%, p = 0.022) and -MACE (5.6% vs 3.0%, p = 0.017) were higher in PAD-patients. MACE at 1 year (18.6% vs 7.9%,p < 0.001) remained increased even after adjustment for confounders (Adj. HR 1.53, 95% CI: 1.14-2.08, p = 0.005). Major bleeding did not differ between groups (Adj. HR 1.18; 95% CI 0.71-1.97, p = 0.512). Although PAD predicted MACE, PAD-patients were prescribed less frequently for secondary prevention at discharge.

CONCLUSIONS

In this real-world ACS patient cohort, concomitant PAD is a marker of VHR and is associated with increased and persistent inflammation, higher risk for MACE without an increased risk of major bleeding. Therefore, a history of PAD may be useful to identify those ACS patients at VHR who require more aggressive secondary prevention.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Gencer, Baris Faruk, Räber, Lorenz, Rodondi, Nicolas

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

0167-5273

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Pubmed Import

Date Deposited:

24 Mar 2023 15:42

Last Modified:

03 Jul 2024 00:25

Publisher DOI:

10.1016/j.ijcard.2023.03.043

PubMed ID:

36958395

Uncontrolled Keywords:

Acute coronary syndrome Peripheral artery disease Personalized therapy Residual risk Risk stratification

BORIS DOI:

10.48350/180603

URI:

https://boris.unibe.ch/id/eprint/180603

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