Prognosis and management of patients with acute coronary syndrome and polyvascular disease.
OBJECTIVE
To assess prognosis and patterns of care in patients with acute coronary syndrome and peripheral arterial disease (PAD), cerebrovascular disease or both (i.e., polyvascular disease) in everyday clinical practice.


METHODS
We used data from the MASCARA acute coronary syndrome registry for 2004 and 2005. Patients were stratified according to the presence of PAD, cerebrovascular disease, neither, or both. In-hospital management, treatment at discharge and outcomes at 6 months were recorded.


RESULTS
Of 6745 patients, 597 (8.85%) had PAD, 392 (5.8%) had cerebrovascular disease, 131 (1.94%) had both and 5625 (83.4%) had neither. Patients with polyvascular disease had more extensive coronary disease, but less often received regularly recommended treatment (e.g., 75% with PAD received aspirin at discharge versus 84% of those without). In-hospital and 6-month mortality were significantly higher (P< .001) in patients with PAD (9.1% and 24.5%, respectively) or cerebrovascular disease (9.2% and 22.4%, respectively) or, especially, both (16.0% and 29.8%, respectively) than in those free from these conditions (4.8% and 10.8%, respectively). Cerebrovascular disease, PAD and their combination were all independently associated with in-hospital and 6-month mortality: for cerebrovascular disease, the odds ratio (OR) for mortality at 6 months was 1.45 (95% confidence interval [CI], 1.10-2.02); for PAD, it was 1.88 (95% CI, 1.45-2.40); and for both combined, 1.88 (95% CI, 1.17-3.00).


CONCLUSIONS
Patients with acute coronary syndrome and concomitant arterial disease had more extensive coronary artery disease and poorer outcomes, both inhospital and at 6 months, but frequently did not receive regularly recommended treatment.
Ferreira-González
Ignacio
I
Area del Cor, Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, España.
Permanyer Miralda
Gaietà
G
Heras
Magda
M
Ribera
Aída
A
Marsal
Josep R
JR
Cascant
Purificación
P
Arós
Fernando
F
Bueno
Héctor
H
Sánchez
Pedro L
PL
Cuñat
José
J
Civeira
Emilia
E
Marrugat
Jaume
J
D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D002561:Cerebrovascular Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D016491:Peripheral Vascular Diseases / Q000150:complications*; D011379:Prognosis; D011446:Prospective Studies