Prognostic impact of peripheral artery disease-related parameters in patients with acute coronary syndrome.
Journal
Journal of cardiovascular medicine (Hagerstown, Md.)
ISSN: 1558-2035
Titre abrégé: J Cardiovasc Med (Hagerstown)
Pays: United States
ID NLM: 101259752
Informations de publication
Date de publication:
02 Aug 2024
02 Aug 2024
Historique:
medline:
5
8
2024
pubmed:
5
8
2024
entrez:
5
8
2024
Statut:
aheadofprint
Résumé
Lower extremity arterial disease (LEAD) and increased aortic stiffness are associated with higher mortality in patients with chronic coronary syndrome, while their prognostic significance after an acute coronary syndrome (ACS) is less known. We analyzed prevalence, clinical phenotypes and association of LEAD - assessed by the ankle-brachial index (ABI) - and increased aortic stiffness - assessed by the aortic pulse wave velocity (PWV) - with all-cause mortality and major adverse cardiovascular events (MACE) in patients admitted with an ACS. Among 270 patients admitted for ACS (mean age 67 years, 80% males), 41 (15%) had an ABI ≤0.9, with 14 of them (34%) presenting with intermittent claudication (symptomatic LEAD). Patients with symptomatic LEAD, compared with those with asymptomatic LEAD or without LEAD, had higher prevalence of cardiovascular risk factors, lower estimated glomerular filtration rate and higher high-sensitivity C-reactive protein. Patients with LEAD, either symptomatic or asymptomatic, more frequently presented with non-ST-elevation myocardial infarction and more frequently had multivessel coronary artery disease. Both symptomatic and asymptomatic LEAD were significantly associated with all-cause mortality after adjustment for confounders, including multivessel disease or carotid artery disease (hazard ratio 4.03, 95% confidence interval 1.61-10.08, P < 0.01), whereas PWV was not associated with the outcome in the univariable model. LEAD and PWV were not associated with a higher risk of MACE (myocardial infarction or unstable angina, stroke, or transient ischemic attack). LEAD, either clinical or subclinical, but not increased aortic stiffness, is an independent predictor of all-cause mortality in patients admitted for ACS.
Sections du résumé
BACKGROUND
BACKGROUND
Lower extremity arterial disease (LEAD) and increased aortic stiffness are associated with higher mortality in patients with chronic coronary syndrome, while their prognostic significance after an acute coronary syndrome (ACS) is less known.
METHODS
METHODS
We analyzed prevalence, clinical phenotypes and association of LEAD - assessed by the ankle-brachial index (ABI) - and increased aortic stiffness - assessed by the aortic pulse wave velocity (PWV) - with all-cause mortality and major adverse cardiovascular events (MACE) in patients admitted with an ACS.
RESULTS
RESULTS
Among 270 patients admitted for ACS (mean age 67 years, 80% males), 41 (15%) had an ABI ≤0.9, with 14 of them (34%) presenting with intermittent claudication (symptomatic LEAD). Patients with symptomatic LEAD, compared with those with asymptomatic LEAD or without LEAD, had higher prevalence of cardiovascular risk factors, lower estimated glomerular filtration rate and higher high-sensitivity C-reactive protein. Patients with LEAD, either symptomatic or asymptomatic, more frequently presented with non-ST-elevation myocardial infarction and more frequently had multivessel coronary artery disease. Both symptomatic and asymptomatic LEAD were significantly associated with all-cause mortality after adjustment for confounders, including multivessel disease or carotid artery disease (hazard ratio 4.03, 95% confidence interval 1.61-10.08, P < 0.01), whereas PWV was not associated with the outcome in the univariable model. LEAD and PWV were not associated with a higher risk of MACE (myocardial infarction or unstable angina, stroke, or transient ischemic attack).
CONCLUSIONS
CONCLUSIONS
LEAD, either clinical or subclinical, but not increased aortic stiffness, is an independent predictor of all-cause mortality in patients admitted for ACS.
Identifiants
pubmed: 39101369
doi: 10.2459/JCM.0000000000001653
pii: 01244665-990000000-00235
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.
Références
Criqui MH, McClelland RL, McDermott MM, Allison MA, Blumenthal RS, Aboyans V, et al. The ankle-brachial index and incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2010; 56:1506–1512.
Perl L, Bental T, Vaknin-Assa H, Assali A, Codner P, Talmor-Barkan Y, et al. Independent impact of peripheral artery disease on percutaneous coronary intervention. J Am Heart Assoc 2020; 9:e017655.
Matetzky S, Natanzon SS, Shlomo N, Atar S, Pollak A, Yosefy C, et al. Peripheral arterial disease in patients with acute coronary syndrome: results from a large real-world registry. Heart Lung Circ 2022; 31:1093–1101.
Denegri A, Magnani G, Kraler S, Bruno F, Klingenberg R, Mach F, et al. History of peripheral artery disease and cardiovascular risk of real-world patients with acute coronary syndrome: Role of inflammation and comorbidities. Int J Cardiol 2023; 382:76–82.
Morillas P, Quiles J, Cordero A, Guindo J, Soria F, Mazón P, et al. Impact of clinical and subclinical peripheral arterial disease in mid-term prognosis of patients with acute coronary syndrome. Am J Cardiol 2009; 104:1494–1498.
Berkovitch A, Iakobishvili Z, Fuchs S, Atar S, Braver O, Eisen A, et al. Peripheral artery disease, abnormal ankle-brachial index, and prognosis in patients with acute coronary syndrome. Front Cardiovasc Med 2022; 9:902615.
Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2014; 63:636–646.
Collaboration TRVfAS Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’. Eur Heart J 2010; 31:2338–2350.
Mattace-Raso FUS, Cammen TJMvd, Hofman A, Popele NMv, Bos ML, Schalekamp MADH, et al. Arterial stiffness and risk of coronary heart disease and stroke. Circulation 2006; 113:657–663.
Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, et al. Recommendations for improving and standardizing vascular research on arterial stiffness. Hypertension 2015; 66:698–722.
Horváth IG, Németh A, Lenkey Z, Alessandri N, Tufano F, Kis P, et al. Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity. J Hypertens 2010; 28:2068–2075.
Špan M, Geršak G, Millasseau SC, Meža M, Košir A. Detection of peripheral arterial disease with an improved automated device: comparison of a new oscillometric device and the standard Doppler method. Vasc Health Risk Manag 2016; 12:305–311.
Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, et al. Measurement and interpretation of the ankle-brachial index. Circulation 2012; 126:2890–2909.
Van Bortel LM, Balkestein EJ, van der Heijden-Spek JJ, Vanmolkot FH, Staessen JA, Kragten JA, et al. Noninvasive assessment of local arterial pulse pressure: comparison of applanation tonometry and echo-tracking. J Hypertens 2001; 19:1037–1044.
Avolio AP, Bortel LMV, Boutouyrie P, Cockcroft JR, McEniery CM, Protogerou AD, et al. Role of pulse pressure amplification in arterial hypertension. Hypertension 2009; 54:375–383.
D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care. Circulation 2008; 117:743–753.
Froehlich JB, Mukherjee D, Avezum A, Budaj A, Kline-Rogers EM, López-Sendón J, et al. Association of peripheral artery disease with treatment and outcomes in acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE). Am Heart J 2006; 151:1123–1128.
Spencer FA, Lessard D, Doubeni C, Yarzebski J, Gore JM, Goldberg RJ. Treatment practices and outcomes of patients with established peripheral arterial disease hospitalized with acute myocardial infarction in a community setting. Am Heart J 2007; 153:140–146.
Lamina C, Meisinger C, Heid IM, Löwel H, Rantner B, Koenig W, et al. Association of ankle-brachial index and plaques in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up. Eur Heart J 2006; 27:2580–2587.
Moussa ID, Jaff MR, Mehran R, Gray W, Dangas G, Lazic Z, et al. Prevalence and prediction of previously unrecognized peripheral arterial disease in patients with coronary artery disease: the Peripheral Arterial Disease in Interventional Patients Study. Catheter Cardiovasc Interv 2009; 73:719–724.
Murabito JM, Keyes MJ, Guo CY, Keaney JF Jr, Vasan RS, D’Agostino RB, et al. Cross-sectional relations of multiple inflammatory biomarkers to peripheral arterial disease: the Framingham Offspring Study. Atherosclerosis 2009; 203:509–514.
Ozkaramanli Gur D, Gur O, Guzel S, Akyuz A, Gurkan S, Alpsoy S, et al. Inflammatory mediators across the spectrum of ankle-brachial index. J Atheroscler Thromb 2019; 26:351–361.
Cassar K, Bachoo P, Ford I, Greaves M, Brittenden J. Platelet activation is increased in peripheral arterial disease. J Vasc Surg 2003; 38:99–103.
Brevetti G, Piscione F, Cirillo P, Galasso G, Schiano V, Barbato E, et al. In concomitant coronary and peripheral arterial disease, inflammation of the affected limbs predicts coronary artery endothelial dysfunction. Atherosclerosis 2008; 201:440–446.
Gremmel T, Xhelili E, Steiner S, Koppensteiner R, Kopp CW, Panzer S. Response to antiplatelet therapy and platelet reactivity to thrombin receptor activating peptide-6 in cardiovascular interventions: differences between peripheral and coronary angioplasty. Atherosclerosis 2014; 232:119–124.
Cordeiro F, Mateus PS, Ferreira A, Leao S, Moz M, Moreira JI. Short-term prognostic effect of prior cerebrovascular and peripheral artery disease in patients with acute coronary syndrome: can we do better? Eur Heart J Acute Cardiovasc Care 2018; 7:652–660.
Weber T, Chirinos JA. Pulsatile arterial haemodynamics in heart failure. Eur Heart J 2018; 39:3847–3854.
Chirinos JA, Segers P, Hughes T, Townsend R. Large-artery stiffness in health and disease. J Am Coll Cardiol 2019; 74:1237–1263.
Chirinos JA, Segers P. Noninvasive evaluation of left ventricular afterload: part 2: arterial pressure-flow and pressure-volume relations in humans. Hypertension 2010; 56:563–570.
Kim H-L, Kim S-H. Pulse wave velocity in atherosclerosis. Front Cardiovasc Med 2019; 6:41.
Tomiyama H, Koji Y, Yambe M, Shiina K, Motobe K, Yamada J, et al. Brachial -- ankle pulse wave velocity is a simple and independent predictor of prognosis in patients with acute coronary syndrome. Circ J 2005; 69:815–822.
Anand SS, Bosch J, Eikelboom JW, Connolly SJ, Diaz R, Widimsky P, et al. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2018; 391:219–229.