Polyvascular disease by systematic vascular screening and adverse outcomes in patients with acute myocardial infarction.

Aims

The prognostic significance of systematically screened extra-coronary vascular disease in patients with acute myocardial infarction (AMI) remains incompletely understood. We investigated the prevalence and prognostic impact of polyvascular disease (PVD) identified using a routine vascular screening strategy in patients with AMI.

Methods

This retrospective single-center observational study included consecutive patients with AMI who underwent percutaneous coronary intervention. Ankle-brachial index (ABI) measurement and carotid ultrasonography were routinely performed during index hospitalization. PVD was defined as the presence of peripheral artery disease (ABI ≤ 0.90) and/or carotid artery disease, defined as carotid plaque according to the Mannheim consensus (maximal wall thickness ≥ 1.5 mm) or ≥50% carotid stenosis. The primary endpoint was a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unplanned coronary revascularization after discharge.

Results

Among 233 eligible patients, PVD was identified in 73 patients (31.3%), including 55 (23.6%) with single-territory PVD and 18 (7.7%) with multiterritory PVD. During a median follow-up of 419 days, the primary endpoint occurred in 43 patients. Kaplan-Meier analysis demonstrated a graded decrease in event-free survival according to increasing PVD burden (log-rank P = 0.014; P for trend = 0.007). In Cox proportional hazards analysis, the presence of PVD was significantly associated with adverse cardiovascular outcomes, and this association remained significant after adjustment for age, sex, diabetes mellitus, and renal dysfunction.

Conclusions

PVD is common in patients with AMI and is associated with poor long-term clinical outcomes. Routine systematic assessment of extra-coronary vascular disease may improve cardiovascular risk stratification.