Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease

被引:9
|
作者
De Luca, Leonardo [1 ]
Di Pasquale, Giuseppe [2 ]
Gonzini, Lucio [3 ]
Chiarella, Francesco [4 ]
Di Chiara, Antonio [5 ]
Boccanelli, Alessandro [6 ]
Casella, Gianni [2 ]
Olivari, Zoran [7 ]
De Servi, Stefano [8 ]
Gulizia, Michele Massimo [9 ]
Di Lenarda, Andrea [10 ]
Savonitto, Stefano [11 ]
Bolognese, Leonardo [12 ]
机构
[1] San Giovanni Evangelista Hosp, Div Cardiol, Rome, Italy
[2] Maggiore Hosp, Dept Cardiol, Bologna, Italy
[3] ANMCO Res Ctr, Florence, Italy
[4] Azienda Osped Univ S Martino, Div Cardiol, Genoa, Italy
[5] Osped St Antonio Abate, Div Cardiol, Tolmezzo, Italy
[6] S Giovanni Addolorata Hosp, Dept Cardiovasc Dis, Rome, Italy
[7] Ca Foncello Hosp, Dept Cardiol, Treviso, Italy
[8] IRCCS Multimed, Div Cardiol, Milan, Italy
[9] Garibaldi Nesima Hosp, Div Cardiol, Catania, Italy
[10] Azienda Sanitaria Univ Integrata Trieste, Div Cardiol, Trieste, Italy
[11] Osped A Manzoni, Div Cardiol, Lecce, Italy
[12] San Donato Hosp, Cardiovasc Dept, Arezzo, Italy
关键词
Acute coronary syndromes; Peripheral arterial disease; Epidemiology; Registries; ACUTE MYOCARDIAL-INFARCTION; POLYVASCULAR DISEASE; GLOBAL REGISTRY; CARE-UNITS; THROMBOLYSIS; REVASCULARIZATION; INTERVENTION; EPIDEMIOLOGY; STRATEGIES; MORTALITY;
D O I
10.1016/j.ejim.2018.08.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS) and peripheral arterial disease (PAD) present a worse prognosis compared to those without PAD. We sought to describe contemporary trends of in-hospital management and outcome of patients admitted for NSTE-ACS with associated PAD. Methods: We analyzed data from 6 Italian nationwide registries, conducted between 2001 and 2014, including consecutive NSTE-ACS patients. Results: Out of 15,867 patients with NSTE-ACS enrolled in the 6 registries, 2226 (14.0%) had a history of PAD. As compared to non-PAD patients, those with PAD had significantly more risk factors and comorbidities (all p < 0.0001) that increased over time. Patients with PAD underwent less frequently coronary angiography (72.0% vs 79.2%, p < 0.0001) and percutaneous coronary intervention (PCI, 42.9% vs 51.8%, p < 0.0001), compared to patients without PAD. Over the years, a progressive and similar increase occurred in the rates of invasive procedures both in patients with and without PAD (both p for trend < 0.0001). The crude in-hospital mortality rate did not significantly change over time (p for trend = 0.83). However, as compared to 2001, the risk of death was significantly lower in all other studies performed at different times, after adjustment for multiple comorbidities.. M multivariable analysis, PAD on admission was an independent predictor of in-hospital mortality [odds ratio (OR): 1.75; 95% confidence intervals (CI): 1.35-2.27; p < 0.0001]. Conclusions: Over the 14 years of observation, patients with PAD and NSTE-ACS exhibited worsening baseline characteristics and a progressive increase in invasive procedures. Whereas crude in-hospital mortality did not change over time, we observed a significant reduction in comorbidity-adjusted mortality, as compared to 2001.
引用
收藏
页码:70 / 76
页数:7
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