title: Association of peripheral artery disease with treatment and outcomes in acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE).
abstract: BACKGROUND
  National guidelines recommend the use of secondary prevention modalities for patients with peripheral artery disease (PAD) and coronary artery disease. The effect of prior PAD on the treatment and outcomes of patients with acute coronary syndromes (ACS), however, is not well characterized. The objectives of this study were to assess treatment practices and hospital outcomes in patients with ACS and prior PAD.
  
  
  METHODS
  Data were analyzed from 41,108 patients aged > or =18 years with ACS and enrolled in the large multinational GRACE between 1999 and 2004.
  
  
  RESULTS
  Of the 41,108 patients, 4003 (9.7%) had prior PAD. Patients with PAD were older, more likely to be men, to have a variety of prior comorbidities, and to present with non-ST-segment elevation myocardial infarction and a higher Killip class than patients without PAD. Patients with PAD were less likely to be treated with effective cardiac medications than patients without PAD. At the time of hospital presentation, patients with prior PAD had low rates of use of beneficial cardiac medications, including angiotensin-converting enzyme inhibitors, aspirin, beta-blockers, and lipid-lowering agents. Patients with PAD were significantly more likely to experience the composite hospital end point (death, shock, recurrent angina, stroke) than patients without prior PAD (adjusted OR 1.17; 95% CI 1.08-1.26).
  
  
  CONCLUSIONS
  Patients with prior PAD received less aggressive treatment with proven cardiac medications during hospitalization for an ACS than patients without PAD. Utilization of beneficial medical therapies in patients with PAD before hospitalization with ACS was also less than optimal. Given the poorer hospital outcomes in patients with PAD, our findings suggest considerable opportunity to improve care for these high-risk patients.
authors.affiliation: University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.forename: Eva M
authors.initials: EM
authors.lastname: Kline-Rogers
authors.forename: José
authors.initials: J
authors.lastname: López-Sendón
authors.forename: Jeanna
authors.initials: J
authors.lastname: Allegrone
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000208:Acute Disease; D000368:Aged; D001158:Arteries; D016022:Case-Control Studies; D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000188:drug therapy; D012042:Registries; D016896:Treatment Outcome