title: Impact of previous vascular burden on in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Patients with a current acute coronary syndrome and previous ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease are reported to have a poorer outcome than those without these previous conditions. It is uncertain whether this association with outcome is observed at long-term follow-up.
  
  
  METHODS
  Prospective observational study, including 4247 patients with ST-segment elevation myocardial infarction. Detailed clinical data and information on previous ischemic heart disease, peripheral arterial disease, and cerebrovascular disease ("vascular burden") were recorded. Multivariate models were performed for in-hospital and long-term (median, 7.2 years) all-cause mortality.
  
  
  RESULTS
  One vascular territory was affected in 1131 (26.6%) patients and ≥ 2 territories in 221 (5.2%). The total in-hospital mortality rate was 12.3% and the long-term incidence density was 3.5 deaths per 100 patient-years. A background of previous ischemic heart disease (odds ratio = 0.83; P = .35), peripheral arterial disease (odds ratio = 1.30; P = .34), or cerebrovascular disease (stroke) (odds ratio = 1.15; P = .59) was not independently predictive of in-hospital death. In an adjusted model, previous cerebrovascular disease and previous peripheral arterial disease were both predictors of mortality at long-term follow-up (hazard ratio = 1.57; P < .001; and hazard ratio = 1.34; P = .001; respectively). Patients with ≥ 2 diseased vascular territories showed higher long-term mortality (hazard ratio = 2.35; P < .001), but not higher in-hospital mortality (odds ratio = 1.07; P = .844).
  
  
  CONCLUSIONS
  In patients with a diagnosis of ST-segment elevation acute myocardial infarction, the previous vascular burden determines greater long-term mortality. Considered individually, previous cerebrovascular disease and peripheral arterial disease were predictors of mortality at long-term after hospital discharge.
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain. Electronic address: lconsue@gmail.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Consuegra-Sánchez
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Melgarejo-Moreno
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Galcerá-Tomás
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Alonso-Fernández
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Angela
authors.initials: A
authors.lastname: Díaz-Pastor
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: Escudero-García
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Jaulent-Huertas
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Vicente-Gilabert
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D014652:Vascular Diseases / Q000150:complications* / Q000453:epidemiology
keywords: Accidente cerebrovascular; Acute myocardial infarction; Cerebrovascular disease; Enfermedad arterial periférica; Infarto de miocardio; Peripheral arterial disease