The Significance of Concomitant Peripheral Artery Disease among Patients Presenting with Acute Coronary Syndrome

Background: Prior large-scale studies have shown that coexistence of peripheral artery disease (PAD) in patients with stable coronary artery disease (CAD) is associated with worse prognosis with higher incidence of recurrent myocardial infarction (MI), stroke, stent thrombosis and eventually death. There is much less data regarding the prevalence and prognostic significance of PAD in patients sustaining acute coronary syndrome (ACS).

Methods: Patients were drawn from the Acute Coronary Syndrome Israeli Survey (ACSIS). In‐hospital, 30‐day, and 1‐year mortality data were documented. PAD was prospectively documented using a pre-specified definition: history of claudication, prior peripheral revascularization, demonstrated of significant occlusive disease or amputation due to vascular cause.

Results: Overall, 16,989 patients hospitalized with ACS were included between the 2000-2018, of whom 1,408 (8.5%) had documented PAD. PAD patients were older (70±11 vs 63±13, p<0.001), had higher prevalence of conventional risk factors: hypertension (73% vs 57%, p<0.001), dyslipidemia (76% vs 63%, p<0.001) and diabetes (56% vs 34%, p<0.001). PAD patients also had higher prevalence of prior myocardial infarction (53% vs 29%, p<0.001), CVA/TIA (22% vs 7%, p<0.001) and chronic renal failure (33% vs 9%, p<0.001). Clinical outcomes revealed a more complicated in-hospital course (significantly higher prevalence of cardiogenic shock, acute renal failure, conduction abnormalities and the need of blood transfusion) as well as higher prevalence of 30 days MACE [Re-MI, Stroke and/or death (12% vs 5%, p<0.001)] and 1-year mortality (22% vs 9%, p<0.001). Multivariable analysis found PAD to be an independent predictor of 30 days MACE (OR 1.6, 95%CI 1.23-2.1) and 1-year mortality (OR 1.55 95%CI 1.34-1.8).

Conclusion: Despite current guidelines recommendations, PAD patients presenting with ACS have complicated in-hospital course as well as both short and long term adverse events. More research is mandatory focusing on this high-risk group of patients.