title: Peripheral artery disease and outcomes after myocardial infarction: an individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT.
abstract: OBJECTIVE
  To examine the prevalence of peripheral artery disease (PAD) and the relationship between PAD and cardiovascular (CV) outcomes in subjects with left ventricular systolic dysfunction, heart failure or both after acute myocardial infarction (MI).
  
  
  BACKGROUND
  PAD is associated with poorer prognosis in patients with stable and unstable coronary heart disease but whether PAD is associated with worse outcomes following substantial acute MI is unknown.
  
  
  METHODS
  Univariate and multivariate Cox proportional hazards modelling was used to compare clinical outcomes in an individual-patient meta-analysis of 4 trials (CAPRICORN, EPHESUS, OPTIMAAL and VALIANT).
  
  
  RESULTS
  Of the 28,771 patients randomized, 2357 (8.2%) had PAD. These patients were older and had more co-morbidity and were less likely to be prescribed aspirin or a beta-blocker compared to patients without PAD. Over a mean follow-up of 2.7 years, 5121 (17.8%) patients died and 15,055 (52.3%) experienced CV death or hospitalization. PAD was an independent predictor of all individual and composite CV outcomes examined (including heart failure), with the exception of stroke. In patients with PAD (compared to those without PAD), the adjusted hazard ratio (HR) for all-cause mortality was 1.25 (95% CI 1.15-1.37; p<0.001) and the HR for CV death, non-fatal MI, non-fatal stroke or heart failure hospitalization was 1.24 (1.16-1.33; p<0.001).
  
  
  CONCLUSIONS
  PAD is common and is an independent predictor of worse outcomes in patients already at high risk after MI because of left ventricular systolic dysfunction, heart failure or both. These patients represent an important group for intensive application of secondary preventive therapies.
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK; Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Sydney Australia.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Inglis
authors.forename: Judith
authors.initials: J
authors.lastname: Bebchuk
authors.forename: Sultan A
authors.initials: SA
authors.lastname: Al-Suhaim
authors.forename: Jessica
authors.initials: J
authors.lastname: Case
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Yingxin Rachel
authors.initials: YR
authors.lastname: Hou
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Dargie
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: John
authors.initials: J
authors.lastname: Kjekshus
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dickstein
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome