Multisite vascular disease in acute coronary syndromes: increased in-hospital mortality and no improvement over time
| Autor: | Franz R. Eberli, Dragana Radovanovic, Giovanni Pedrazzini, Juan F. Iglesias, Hans Rickli, Paul Erne, Marco Roffi, Philip Urban |
|---|---|
| Přispěvatelé: | University of Zurich |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Population Infarction 610 Medicine & health 030204 cardiovascular system & hematology Coronary Angiography Critical Care and Intensive Care Medicine Coronary artery disease 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Humans Medicine Hospital Mortality Prospective Studies Registries Vascular Diseases 030212 general & internal medicine Myocardial infarction Acute Coronary Syndrome education Stroke Aged Killip class education.field_of_study business.industry Vascular disease Incidence 10060 Epidemiology Biostatistics and Prevention Institute (EBPI) General Medicine Middle Aged Prognosis medicine.disease Comorbidity Survival Rate Cardiology Female business Cardiology and Cardiovascular Medicine Switzerland Follow-Up Studies |
| Popis: | Introduction: Limited data are available on the impact of multisite artery disease in patients with acute coronary syndromes. In particular, it is unknown whether the outcomes of those high-risk patients have improved over time. Therefore, we addressed the multisite artery disease patient population enrolled in the Swiss nationwide prospective acute coronary syndromes cohort study AMIS Plus over two decades. Methods: All patients enrolled from January 1999 to October 2016 were stratified according to the presence of isolated coronary artery disease or multisite artery disease, defined as coronary artery disease with known concomitant vascular disease (i.e. cerebrovascular disease and/or peripheral artery disease). Multisite artery disease 1 (MSAD1) and multisite artery disease 2 (MSAD2) defined patients with one and two additional vascular conditions, respectively. Primary outcome measures were in-hospital mortality and major adverse cardiovascular events (defined as re-infarction, stroke or death). Results: Among a total of 44,157 patients, 39,613 (89.7%) had coronary artery disease only while 4544 (10.3%) had multisite artery disease (4097 (9.3%) had MSAD1 and 447 (1.0%) had MSAD2). Compared with patients with coronary artery disease only, multisite artery disease patients were older, had a longer delay from symptom onset to hospital admission, had more frequently atypical presentation, presented more frequently with non-ST-segment elevation acute coronary syndromes, were more frequently in Killip class III/IV, had higher Charlson comorbidity index, more frequently had three-vessel coronary artery disease and were treated less frequently with evidence-based treatments such as aspirin, P2Y12 inhibitors, or beta-blockers. Similarly, multisite artery disease benefitted less frequently from coronary angiography as well as percutaneous coronary revascularisation. In-hospital mortality was 10.9% in multisite artery disease patients and 4.4% in coronary artery disease-only patients (P Conclusion: Patients presenting with multisite artery disease were less likely to receive evidence-based therapies than coronary artery disease-only patients and had increased in-hospital morbidity and mortality, with no improvement over time. The worse outcomes were observed among MSAD2 patients. These results should prompt awareness for multisite artery disease as a high-risk condition in the setting of multisite artery disease. |
| Databáze: | OpenAIRE |
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