title: Usefulness of the presence of peripheral vascular disease in predicting mortality in acute myocardial infarction patients treated with primary angioplasty (from the Primary Angioplasty in Myocardial Infarction Database).
abstract: Patients with acute myocardial infarction (AMI) often have multiple co-morbidities that influence outcome. We sought to evaluate the impact of peripheral vascular disease (PVD) on the outcome of patients with AMI treated with primary angioplasty. We evaluated 3,716 patients with AMI who underwent emergency catheterization with planned primary angioplasty in the Primary Angioplasty in Myocardial Infarction trials. Patients with a history of PVD (claudication, stroke, or transient ischemic attack) were compared with patients without PVD. Of the 3,716 patients, 394 (10.6%) had PVD and were older, more often women, and more frequently had a history of diabetes mellitus, hypertension, smoking, congestive heart failure, angina, myocardial infarction, and coronary revascularization. They presented more often with a heart rate >100 beats/min, Killip class >1, lower ejection fraction, and multivessel disease. No difference was found in stent use, final percentage of stenosis, or Thrombolysis In Myocardial Infarction 3 flow. Patients with PVD had a twofold increased in-hospital mortality (5.3% vs 2.6%, p = 0.0021). The difference remained significant at 1 month, 6 months, and 1 year (12.6% vs 6%, p < 0.0001). In multivariate logistic regression analysis, a history of PVD was an independent predictor of in-hospital mortality and death at 1 year (odds ratio 1.64, 95% confidence interval 1.04 to 2.57, p = 0.032). In conclusion, patients with AMI with PVD have increased co-morbidities and higher mortality despite treatment with primary angioplasty. The presence of PVD is an independent predictor of in-hospital mortality and death at 1 year.
authors.affiliation: William Beaumont Hospital, Royal Oak, Michigan, USA. mguerrero@beaumont.edu
authors.forename: Mayra
authors.initials: M
authors.lastname: Guerrero
authors.forename: Kishore
authors.initials: K
authors.lastname: Harjai
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Bruce
authors.initials: B
authors.lastname: Brodie
authors.forename: David
authors.initials: D
authors.lastname: Cox
authors.forename: Judy
authors.initials: J
authors.lastname: Boura
authors.forename: Lorelei
authors.initials: L
authors.lastname: Grines
authors.forename: William
authors.initials: W
authors.lastname: O'Neill
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
mesh_terms: D000368:Aged; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D019992:Databases as Topic; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D011446:Prospective Studies; D016896:Treatment Outcome