Abstract 2216: Polyvascular Disease - A Novel Risk Factor for Worse Ischemic and Bleeding Outcomes in Acute Coronary Syndromes
Background: The presence of peripheral arterial disease (PAD) or cerebrovascular disease (CVD) increases the likelihood of significant coronary artery disease (CAD). The impact of PAD, CVD, prior CAD, or pre-existent disease in multiple arterial territories (“polyvascular” disease) in patients presenting with non-ST elevation acute coronary syndromes (ACS) has not been well studied.
Methods: A total of 95,749 patients enrolled from February 15, 2003 to September 30, 2006 at 484 sites in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) registry were analyzed. Patients were categorized as having prior 0, 1, 2, or 3 affected arterial beds. The rates of in-hospital mortality, myocardial infarction (MI), stroke, and congestive (CHF) were analyzed, as were the rates of non-bypass surgery red blood cell transfusions.
Results: On presentation, a total of 11,345 (11.9%) patients had established PAD, 9,973 (10.4%) had documented CVD, and 41,404 (43.2%) had prior CAD. In this cohort, 0, 1, 2, and 3 arterial bed disease was present in 46,814 (48.9%), 36,704 (38.3%), 10,675 (11.2%), and 1,556 (1.6%) patients. The rates of ischemic events, as well as transfusion, increased with the number of affected vascular beds, as shown in the Table⇓. The adjusted odds ratio for in-hospital ischemic events for pre-existent disease in 1, 2, or 3 arterial beds (compared to 0 arterial bed involvement) increased from 1.07 to 1.25 to 1.30 (p<0.001). Similarly, the adjusted odds ratio for transfusion increased with greater disease burden from 1.11 to 1.28 to 1.30 (p<0.001).
Conclusions: Polyvascular disease, present in ~13% of patients presenting with ACS, dramatically increases the risk of in-hospital adverse events, including mortality. Future efforts should be directed towards better identification of these patients and targeted therapies to reduce their excess risk.