Impact of pre-existing vascular disease on clinical outcomes.
Eur Heart J Qual Care Clin Outcomes
; 9(1): 64-75, 2022 12 13.
Article
em En
| MEDLINE
| ID: mdl-35575608
ABSTRACT
AIMS:
Little is known about the outcomes and processes of care of patients with non-ST-segment myocardial infarction (NSTEMI) who present with 'polyvascular' disease. METHODS ANDRESULTS:
We analysed 287 279 NSTEMI patients using the Myocardial Ischaemia National Audit Project registry. Clinical characteristics and outcomes were analysed according to history of affected vascular bed-coronary artery disease (CAD), cerebrovascular disease (CeVD), and peripheral vascular disease (PVD)-with comparison to a historically disease-free control group, comprising 167 947 patients (59%). After adjusting for demographics and management, polyvascular disease was associated with increased likelihood of major adverse cardiovascular events (MACEs) [CAD odds ratio (OR) 1.06; 95% confidence interval (CI) 1.01-1.12; P = 0.02] (CeVD OR 1.19; 95% CI 1.12-1.27; P < 0.001) (PVD OR 1.22; 95% CI 1.13-1.33; P < 0.001) and in-hospital mortality (CeVD OR 1.24; 95% CI 1.16-1.32; P < 0.001) (PVD OR 1.33; 95% CI 1.21-1.46; P < 0.001). Patients without vascular disease were less frequently discharged on statins (PVD 88%, CeVD 86%, CAD 90%, and control 78%), and those with moderate [ejection fraction (EF) 30-49%] or severe left ventricular systolic dysfunction (EF < 30%) were less frequently discharged on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) (CAD 82%, CeVD 77%, PVD 77%, and control 74%). Patients with polyvascular disease were less likely to be discharged on dual antiplatelet therapy (DAPT) (PVD 78%, CeVD 77%, CAD 80%, and control 87%).CONCLUSION:
Polyvascular disease patients had a higher incidence of in-hospital mortality and MACEs. Patients with no history of vascular disease were less likely to receive statins or ACE inhibitors/ARBs, but more likely to receive DAPT.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Inibidores de Hidroximetilglutaril-CoA Redutases
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Infarto do Miocárdio
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article