title: Prognosis and management of patients with acute coronary syndrome and polyvascular disease.
abstract: 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.
authors.affiliation: Area del Cor, Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, España.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-González
authors.forename: Gaietà
authors.initials: G
authors.lastname: Permanyer Miralda
authors.forename: Magda
authors.initials: M
authors.lastname: Heras
authors.forename: Aída
authors.initials: A
authors.lastname: Ribera
authors.forename: Josep R
authors.initials: JR
authors.lastname: Marsal
authors.forename: Purificación
authors.initials: P
authors.lastname: Cascant
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sánchez
authors.forename: José
authors.initials: J
authors.lastname: Cuñat
authors.forename: Emilia
authors.initials: E
authors.lastname: Civeira
authors.forename: Jaume
authors.initials: J
authors.lastname: Marrugat
mesh_terms: 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