title: Long term prognostic value of subclinical carotid and femoral arterial wall lesions in patients with ST-elevation-myocardial infarction having percutaneous coronary intervention.
abstract: The presence of clinical peripheral arterial disease (PAD) is associated with an increased risk for adverse cardiovascular outcomes in patients with coronary artery disease. However, there are few data regarding the impact of the presence and degree of the subclinical PAD on outcomes in patients with coronary artery disease. The aim of this study was to assess prospectively the grade of subclinical PAD in the setting of patients who underwent primary percutaneous coronary intervention for the prediction of intermediate- and long-term clinical outcomes. A total of 971 consecutive patients without histories of clinical PAD who under went primary percutaneous coronary intervention for ST-segment elevation myocardial infarction were included in a prospective follow-up. Subclinical PAD severity was blindly assessed on the basis of an ultrasound arterial morphologic classification defined with the assessment of wall carotid and femoral artery bifurcations. This classification included 4 increasing classes of subclinical carotid and femoral arterial wall lesions, and the total group was divided accordingly. Death and major cardiovascular and cerebrovascular events were evaluated. During a median follow-up period of 40 months, a total of 109 patients (11.2%) died, 9 (2.8%) in class I, 12 (3.1%) in class II, 37 (23.7%) in class III, and 51 (49.0%) in class IV (p <0.001). On multivariate analysis, mortality in class IV was sevenfold higher (hazard ratio [HR] 7.34, 95% confidence interval [CI] 3.3 to 16.33, p <0.001) compared to class I and was also increased in class III (HR 5.38, 95% CI 2.42 to 11.92, p <0.001). Similar results were obtained for major adverse cardiovascular and cerebrovascular events in class IV (HR 7.50, 95% confidence interval 5.36 to 10.50, p <0.0001), class III (HR 6.44, 95% CI 4.45 to 9.32, p <0.001), and class II (HR 1.73, 95% CI 1.23 to 2.43, p = 0.002). In conclusion, ultrasound arterial morphologic classification may be applied in patients with ST-segment elevation myocardial infarctions who undergo primary percutaneous coronary intervention and can stratify patients for poor clinical outcomes during long-term follow-up.
authors.affiliation: University Hospital of Modena, Modena, Italy. demonopoli@gmail.com
authors.forename: Daniel Enrique
authors.initials: DE
authors.lastname: Monopoli
authors.forename: Luca
authors.initials: L
authors.lastname: Bertelli
authors.forename: Fabio Alfredo
authors.initials: FA
authors.lastname: Sgura
authors.forename: Luigi
authors.initials: L
authors.lastname: Politi
authors.forename: Mirza
authors.initials: M
authors.lastname: Becirovic
authors.forename: Daniele
authors.initials: D
authors.lastname: Iaccarino
authors.forename: Antonella
authors.initials: A
authors.lastname: Lattanzi
authors.forename: Katia
authors.initials: K
authors.lastname: Rampino
authors.forename: Giulia
authors.initials: G
authors.lastname: Gorlato
authors.forename: Mila
authors.initials: M
authors.lastname: Menozzi
authors.forename: Romeo Giulietto
authors.initials: RG
authors.lastname: Zennaro
authors.forename: Rosario
authors.initials: R
authors.lastname: Rossi
mesh_terms: D000368:Aged; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis; D002339:Carotid Arteries; D004562:Electrocardiography; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex