Abstract 18014: Did Patients With Peripheral Artery Disease Benefit From the Survival Improvement After Myocardial Infarction? Insights From the FAST-MI Program, 1995-2010
Introduction: Patients with peripheral artery disease (PAD) are at risk for acute myocardial infarction (AMI). The prognosis of patients after AMI has substantially improved over the last 20 years. Whether survival has similarly improved in patients with or without PAD is unknown.
Methods: We compared the management and mortality after AMI according to clinical PAD status in 4 French nationwide registries conducted with similar methodology in 1995, 2000, 2005 and 2010. Each included during one month all patients admitted to cardiology departments in general, academic or private hospitals for AMI with symptoms onset ≤ 48 hours.
Results: Among the 10,610 patients, 962 (9.1%) had PAD. PAD remained constant in NSTEMI patients (12%), while it decreased from 9.7% to 4.8% among STEMI patients. Median age increased in PAD patients (1995 vs 2010: 73 vs 75 years, P<0.05) but decreased in no-PAD patients (65 to 63 years, P<0.04). Women’s rates remained stable (PAD: 26 to 22%, no-PAD 29 to 27%). High cholesterol, obesity, diabetes, and hypertension rates increased significantly, irrespective of PAD status. Smoking rates decreased in PAD patients (29% to 23%, P=0.02), but increased in no-PAD patients (31 to 35%, P=0.02). The rates of early PCI (<72 hours) increased (PAD: 10% to 48%; no-PAD: 15 to 72%); so did the early use of antiplatelet drugs (PAD: 84% to 98 %; no-PAD: 92 to 98%), ACE-I or ARBs (PAD: 45 to 56%; no-PAD: 46 to 64%), beta-blockers (PAD: 48 to 71%; no-PAD: 66 to 80%) and statins (PAD: 10% to 85%; no-PAD: 10 to 88%).
In PAD patients, 30-day mortality decreased from 23.5% to 5.3% (HR 2010 vs 1995, adjusted for baseline characteristics: 0.23, 0.12-0.43). Their 1-year mortality decreased from 33 to 23% (HR 0.60, 0.41-0.88), but among 30-day survivors, no favorable trend was found for 1-year mortality (adjusted HR 2010 vs 1995: 1.54, 0.87-2.71). In no-PAD patients, adjusted HR for 30-day death (2010 vs 1995) was 0.33, (0.26-0.43), and 1-year survival also improved among 30-day survivors (adjusted HR 0.65, 0.50-0.85).
Conclusion: After AMI, early survival has considerably increased in PAD patients as for no-PAD patients. However, no further survival improvement has been found in PAD patients beyond the 30 days, emphasizing the need for stronger secondary prevention.
Author Disclosures: V. Aboyans: None. E. Puymirat: None. F. Schiele: None. M. Elbaz: None. S. Cattan: None. D. Blanchard: None. P. Henry: None. J. Ferrières: None. T. Simon: None. N. Danchin: None.
- © 2015 by American Heart Association, Inc.