Impact of Previous Vascular Burden on In-hospital and Long-term Mortality in Patients With ST-segment Elevation Myocardial Infarction

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• 作者：Luciano Consuegra-S&aacute ; nchez^a ; ^{lconsue@gmail.com" class="auth_mail} ; Antonio Melgarejo-Moreno^b ; José ; Galcer&aacute ; -Tom&aacute ; s^c ; Nuria Alonso-Fern&aacute ; ndez^b ; Angela Dí ; az-Pastor^b ; Germ&aacute ; n Escudero-Garcí ; a^b ; Leticia Jaulent-Huertas^a ; Marta Vicente-Gilabert^c
• 关键词：CVD ; cerebrovascular disease ; IHD ; ischemic heart disease ; PAD ; peripheral arterial disease ; STEAMI ; ST-segment elevation acute myocardial infarction
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：June 2014
• 年：2014
• 卷：67
• 期：6
• 页码：471-478
• 全文大小：341 K

文摘

Patients with a current acute coronary syndrome and previous ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease are reported to have a poorer outcome than those without these previous conditions. It is uncertain whether this association with outcome is observed at long-term follow-up.

Methods

Prospective observational study, including 4247 patients with ST-segment elevation myocardial infarction. Detailed clinical data and information on previous ischemic heart disease, peripheral arterial disease, and cerebrovascular disease («vascular burden») were recorded. Multivariate models were performed for in-hospital and long-term (median, 7.2 years) all-cause mortality.

Results

One vascular territory was affected in 1131 (26.6%) patients and ≥ 2 territories in 221 (5.2%). The total in-hospital mortality rate was 12.3% and the long-term incidence density was 3.5 deaths per 100 patient-years. A background of previous ischemic heart disease (odds ratio = 0.83; P = .35), peripheral arterial disease (odds ratio = 1.30; P = .34), or cerebrovascular disease (stroke) (odds ratio = 1.15; P = .59) was not independently predictive of in-hospital death. In an adjusted model, previous cerebrovascular disease and previous peripheral arterial disease were both predictors of mortality at long-term follow-up (hazard ratio = 1.57; P < .001; and hazard ratio = 1.34; P = .001; respectively). Patients with ≥ 2 diseased vascular territories showed higher long-term mortality (hazard ratio = 2.35; P < .001), but not higher in-hospital mortality (odds ratio = 1.07; P = .844).

Conclusions

In patients with a diagnosis of ST-segment elevation acute myocardial infarction, the previous vascular burden determines greater long-term mortality. Considered individually, previous cerebrovascular disease and peripheral arterial disease were predictors of mortality at long-term after hospital discharge.