A study to assess frequency of peripheral arterial disease in patients presenting with acute coronary syndrome
Keywords:Acute coronary syndrome, Peripheral arterial disease
Background: To determine the frequency of peripheral arterial disease (PAD) in patients presenting with acute coronary syndrome (ACS) and association of PAD with different risk factors of coronary artery disease (CAD) and to look for in hospital outcome of ACS patients with or without PAD.
Methods: This cross-sectional observation study was undertaken in the department of cardiology, IPGME&R Hospital, Kolkata from June 2015 to August 2016 to recruit 199 consecutive patients admitted with ACS and were evaluated with detailed clinical history, physical examination, ABI (Ankle Brachial Index) measurement, echocardiography and appropriate blood investigations.
Results: Among 199 total ACS patients, STEMI was the predominant mode of presentation (71.86%) and majorities were male. PAD was seen in 26 patients and mean age was 56.68±8.84 years. Factors independently related with PAD in acute coronary syndromes are hypertension (OR- 1.49; 95% CI: 0.615-3.232), diabetes (OR- 2.55;95% CI : 0.9762-6.6665), smoking (OR-2.55; 95% CI: 1.055-6.19), past history of CVA (OR-11.15;95% CI: 1.77-70.32), LV systolic dysfunction (OR-1.388; 95% CI:0.607-3.1742). 2 and 13 patients died within 7 days of admission among 26 ACS-PAD group (7.69%) and 173 ACS-non-PAD group (7.5%) respectively and most of them had STEMI.
Conclusions: Significant numbers of ACS patients are having PAD and older age, male sex, diabetes, hypertension, smoking and LV systolic dysfunction were found to be independent predictors for PAD in ACS patients. Early in hospital mortality was seem to be dependent on clinical presentation, not on presence or absence of PAD.
American Heart Association/American Stroke Asssociation statistical data on highlights of acute coronary syndrome; 2005.
Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349:1269-76.
Scirica BM, David A. Morrow “ST-Elevation Myocardial Infarction: Pathology, Pathophysiology, andClinical Features” Braunwald Heart Disease- A text book of cardiovascular medicine, 10th ed, chapter 51;2015:1068.
Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/ AHA 2005 guidelines for the management of patients with peripheral arterial disease: Executive summary. J Am Coll Cardiol. 2006;47:1239-312.
Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med. 1992;326:381-6.
Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness and treatment in primary care. JAMA. 2001;286:1317-24.
Wattanakit K, Folsom AR, Selvin E, Weatherley BD, Pankow JS, Brancati FL, et al. Risk factors for peripheral arterial disease incidence in persons with diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. Atherosclerosis. 2005;180:389-97.
Sukhija R, Aronow WS, Yalamanchili K, Peterson SJ, Frishman WH, Babu S. Association of ABI with severity of angiographic CAD in patients with PAD and CAD. Cardiol. 2005;103:158-60.
Januzzi JL, Buros J, Cannon CP. Peripheral arterial disease, acute coronary syndromes, and early invasive management: the TACTICS TIMI 18 trial. Clin Cardiol. 2005;28(5):238-42.
Cotter G, Cannon CP, McCabe CH. Prior peripheral arterial disease and cerebrovascular disease are independent predictors of adverse outcome in patients with acute coronary syndromes: are we doing enough? Results from the orbofiban in patients with unstable coronary syndromes-thrombolysis in myocardial infarction (OPUS-TIMI) 16 study. Am Heart J. 2003;145(4):622-7.
Mukherjee D, Eagle KA, Kline-Rogers E. Impact of prior peripheral arterial disease and stroke on outcomes of acute coronary syndromes and effect of evidence-based therapies (from the global registry of acute coronary events). Am J Cardiol. 2007;100:1-6.
Morillas P, Quiles J, Cordero A. Impact of clinical and subclinical peripheral arterial disease in mid-term prognosis of patients with acute coronary syndrome. Am J Cardiol. 2009;104(11):1494-8.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet. 2004;364:937-52.
Sharma R, Bhairappa S, Prasad SR, Manjunath CN. Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south Indian population. Heart India 2014;2:65-9.
Rogers WJ, Frederick PD, Stoehr E. Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J. 2008;156:1026.
Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371(9622):1435-42.
Bertomeu V, Morillas P, Gonzalez-Juanatey JR. Prevalence of peripheral arterial disease in patients with acute coronary s´ındrome (PAMISCA) Investigators. Prevalence and prognostic influence of peripheral arterial disease in patients ≥40 years old admitted into hospital following an acute coronary event. Eu J Vasc Endovasc Surg. 2008;36(2):189-96.
Leong BDK, Zainal AA, Chuah JA, Voo SY, Prevalence of peripheral arterial disease and abdominal aortic aneurysm among patients with acute coronary syndrome. Med J Malaysia. 2013;68(1).
Al-Thani HA, El-Menyar A, Zubaid M, Rashed WA. Peripheral arterial disease in patients presenting with acute coronary syndrome in sixmiddle eastern countries. Int J Vascu Med. 2011:Article ID 815902,
Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators. N Engl J Med. 1999;341:226-32.
Chang WC, Kaul P, Westerhout CM, Graham MM, Fu Y, Chowdhury T, et al. Impact of sex on long-term mortality from acute myocardial infarction vs unstable angina. Arch Intern Med. 2003;163:2476-84.
Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease in the elderly: the rotterdam study. Arterioscler Thromb Vasc Biol. 1998;18:185-92.
Newman AB, Siscovick BS, Manolio TA. Ankle arm index as a marker of atherosclerosis - the Cardiovascular Health Study. Circulat. 1993;88:837-45.
McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure - the Framingham Study. N Engl J Med. 1971;285:1441-6.
Reunanen A, Takkunen H, Aromaa A. Prevalence of intermittent claudication and its effect on mortality. Acta Med Scand. 1982;211:249-56.