title: Impact of prior peripheral arterial disease and stroke on outcomes of acute coronary syndromes and effect of evidence-based therapies (from the Global Registry of Acute Coronary Events).
abstract: We assessed the effect of previous peripheral arterial disease (PAD) and stroke on clinical outcomes in patients with acute coronary syndrome (ACS) and sought to ascertain the effectiveness of evidence-based therapies in these patients. We used data from the multinational Global Registry of Acute Coronary Events. Patients were enrolled at 102 hospitals in 13 countries between April 1999 and September 2005. Patients presenting with ACS were stratified according to the presence of previous PAD, stroke, PAD and stroke, or neither. In-hospital analysis included 48,418 patients and 6-month analysis included 32,735 patients. The primary end point was all-cause mortality and major adverse cardiac events during 6-month follow-up. Adverse in-hospital and 6-month events were lowest in patients with neither PAD nor stroke and highest in patients with PAD and stroke after adjustment for baseline demographics and co-morbidities. In-hospital mortality for the 4 groups (neither, PAD, stroke, PAD and stroke) was 4.5% versus 7.2% versus 8.9% versus 9.4% (p <0.001) and that for 6-month mortality was 3.9% versus 8.8% versus 9.3% versus 12%, and these differences persisted after accounting for differences in baseline characteristics. Use of evidence-based therapies was associated with significantly less morbidity and mortality in all ACS subgroups. In conclusion, outcomes after ACS are worse in patients with PAD or stroke, with the highest risk in patients with the 2 conditions and the use of evidence-based therapies are associated with improved outcomes in all ACS subgroups.
authors.affiliation: Gill Heart Institute and the University of Kentucky, Lexington, Kentucky, USA. mukherjee@uky.edu
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Eva
authors.initials: E
authors.lastname: Kline-Rogers
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Feldman
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Juliard
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: Jeanna
authors.initials: J
authors.lastname: Allegrone
authors.forename: Gordon
authors.initials: G
authors.lastname: FitzGerald
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000188:drug therapy; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012042:Registries; D020521:Stroke / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors