Abstract 2764: Impact of Polyvascular Disease on Baseline Characteristics, Management and Hospital Mortality in Acute Myocardial Infarction
Background: The impact of polyvascular disease (PVD) on baseline characteristics, management and outcomes after myocardial infarction is not well known.
Methods: The ALLIANCE project is a meta-analysis of individual data from 5 registries of patients admitted with myocardial infarction throughout France from 2000 to 2005 representing 9783 patients. Data were collected on history of peripheral arterial disease (PAD) and stroke/TIA.
Results: 8904 patients had full datasets. 13.0% had a history of previous stroke, TIA or PAD, whereas 87.0% did not. Patients with PVD were older (72.4 vs 65.0 years, p<0.0001), had more frequent history of MI (26.1 vs 14.7%, p<0.0001), PCI, CABG, renal insufficiency (11.9 vs 2.5%, p<0.0001) and more risk factors for atherosclerosis (hypertension, dyslipidemia, smoking, diabetes), but less frequently a BMI > 30 (14.0 vs 20.1%, p<0.0001) than patients with single vascular disease (SVD). Killip class, LVEF and GUSTO risk score were all worse among patients with polyvascular disease. Management of pts with PVD was less aggressive (with later admission, less frequent use of in-hospital angiography and less use of evidence-based therapies at discharge) Mortality of patients with PVD was higher than in SVD, regardless of age (table⇓). On multivariate analysis, both PAD (OR: 1.3 95%CI: 1.03–1.79) and history of stroke/TIA (OR 1.7, 95%CI: 1.27–2.40) were independent predictors of increased hospital mortality.
Conclusion: patients with PVD are a large subset of MI patients, at particularly high risk of death. Yet, they are managed less aggressively than patients with SVD. This is associated with a markedly higher in-hospital mortality.