期刊
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
卷 5, 期 4, 页码 541-549出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCOUTCOMES.111.964379
关键词
myocardial infarction; peripheral vascular disease; coronary diseasece; rebrovascular disorders; aged
资金
- Schering-Plough Corporation
- Bristol-Myers Squibb/sanofi Pharmaceuticals
- Millennium Pharmaceuticals Inc
- National Institute on Aging [R01 AG025312-01A1]
- Amarin
- AstraZeneca
- Bristol-Myers Squibb
- Eisai
- Ethicon
- Medtronic
- Sanofi-aventis
- Medicines Company
- Merck
- Canyon Pharmaceuticals
- Heartscape
- Eli Lilly/Daiichi Sankyo
- MAQUET Cardiovascular LLC
- Johnson Johnson
- National Heart, Lung, and Blood Institute
- Agency for Healthcare Research and Quality and consults for Genzyme
- Daiichi Sankyo
- Datascope
- Eli Lilly Company
- Merck Co
- American Heart Association
- American College of Cardiology
- Society of Thoracic Surgeons and consults for Boehringer Ingelheim
- Roche
Background-The impact of polyvascular disease (peripheral arterial disease [PAD] and cerebrovascular disease [CVD]) on long-term cardiovascular outcomes among older patients with acute myocardial infarction has not been well studied. Methods and Results-Patients with non-ST-segment-elevation myocardial infarction aged >= 65 years from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines) registry who survived to hospital discharge were linked to longitudinal data from the Centers for Medicare & Medicaid Services (n=34 205). All patients were presumed to have coronary artery disease (CAD) and were classified into the following 4 groups: 10.7% with prior CVD (CAD+CVD group); 11.5% with prior PAD (CAD+PAD); 3.1% with prior PAD and CVD (CAD+PAD+CVD); and 74.7% with no polyvascular disease (CAD alone). Cox proportional hazards modeling was used to examine the hazard of long-term mortality and composite of death or readmission for myocardial infarction or stroke (median follow-up, 35 months; interquartile range, 17-49 months). Compared with the CAD alone group, patients with polyvascular disease had greater comorbidities, were less likely to undergo revascularization, and received less often recommended discharge interventions. Three-year mortality rates increased with number of arterial bed involvement as follows: 33% for CAD alone, 49% for CAD+PAD, 52% for CAD+CVD, and 59% for CAD+PAD+CVD. Relative to the CAD alone group, patients with all 3 arterial beds involved had the highest risk of long-term mortality (adjusted hazard ratio [95% CI], 1.49 [1.38-1.61]; CAD+CVD, 1.38 [1.31-1.44]; CAD+PAD, 1.29 [1.23-1.35]). Similarly, the risk of long-term composite ischemic events was highest among patients in the CAD+PAD+CVD group. Conclusions-Among older patients with non-ST-segment-elevation myocardial infarction, those with polyvascular disease have substantially higher long-term risk for recurrent events or death. Future studies targeting greater adherence to secondary prevention strategies and novel therapies are needed to help to reduce long-term cardiovascular events in this vulnerable population. (Circ Cardiovasc Qual Outcomes. 2012; 5: 541-549.)
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