Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN,EPEHESUS, OPTIMAAL and VALIANT |
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| Authors: | Sally C. Inglis Judith Bebchuk Sultan A. Al-Suhaim Jessica Case Marc A. Pfeffer Scott D. Solomon Yingxin Hou Bertram Pitt Henry J. Dargie Ian Ford John Kjekshus Faiez Zannad Kenneth Dickstein John J.V. McMurray |
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| Affiliation: | 1. BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK;2. Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia;3. Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Sydney Australia;4. Statistics Collaborative Inc., Washington DC, USA;5. Department of Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, USA;6. Department of Medicine, University of Michigan, Ann Arbor, USA;g Cardiology Department, Western Infirmary, Glasgow, UK;h Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK;i Department of Cardiology, Oslo University Hospital, Oslo, Norway;j INSERM, CIC9501 and U961, CHU Nancy, Hypertension and Heart Failure Unit, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine, 54500 Vandoeuvre les Nancy, France;k Stavanger University Hospital, Department of Cardiology, Stavanger, Norway |
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| Abstract: | ObjectivesTo examine the prevalence of peripheral artery disease (PAD) and the relationship between PAD and cardiovascular (CV) outcomes in subjects with left ventricular systolic dysfunction, heart failure or both after acute myocardial infarction (MI).BackgroundPAD is associated with poorer prognosis in patients with stable and unstable coronary heart disease but whether PAD is associated with worse outcomes following substantial acute MI is unknown.MethodsUnivariate and multivariate Cox proportional hazards modelling was used to compare clinical outcomes in an individual-patient meta-analysis of 4 trials (CAPRICORN, EPHESUS, OPTIMAAL and VALIANT).ResultsOf the 28,771 patients randomized, 2357 (8.2%) had PAD. These patients were older and had more co-morbidity and were less likely to be prescribed aspirin or a beta-blocker compared to patients without PAD. Over a mean follow-up of 2.7 years, 5121 (17.8%) patients died and 15,055 (52.3%) experienced CV death or hospitalization. PAD was an independent predictor of all individual and composite CV outcomes examined (including heart failure), with the exception of stroke. In patients with PAD (compared to those without PAD), the adjusted hazard ratio (HR) for all-cause mortality was 1.25 (95% CI 1.15–1.37; p < 0.001) and the HR for CV death, non-fatal MI, non-fatal stroke or heart failure hospitalization was 1.24 (1.16–1.33; p < 0.001).ConclusionsPAD is common and is an independent predictor of worse outcomes in patients already at high risk after MI because of left ventricular systolic dysfunction, heart failure or both. These patients represent an important group for intensive application of secondary preventive therapies. |
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| Keywords: | ACE, Angiotensin-converting-enzyme CAPRICORN, Carvedilol on Outcome after Myocardial Infarction in Patients with Left Ventricular Dysfunction trial CV, Cardiovascular EPHESUS, Eplerenone's Neurohormonal Efficacy and Survival Study HF, Heart failure HR, Hazard ratio MI, Myocardial Infarction OPTIMAAL, Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan PAD, Peripheral artery disease VALIANT, Valsartan in Acute Myocardial Infarction trial |
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