Impact of Previous Vascular Burden on In-hospital and Long-term Mortality in Patients With ST-segment Elevation Myocardial Infarction

Introduction and objectives: 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. (C) 2013 Sociedad Espanola de Cardiologi a. Published by Elsevier Espana, S. L. All rights reserved.