VA Boston Healthcare System and Brigham and Women's Hospital, Boston, MA, USA.
Eur Heart J. 2009 May;30(10):1195-202. doi: 10.1093/eurheartj/ehp099. Epub 2009 Apr 1.
The presence of peripheral arterial disease (PAD) or cerebrovascular disease (CVD) is associated with higher likelihood of significant coronary artery disease (CAD). We sought to assess the prevalence of PAD, CVD, prior CAD, or pre-existent disease in multiple arterial territories ('polyvascular' disease) in patients presenting with non-ST-segment elevation acute coronary syndrome and its impact on adverse events.
Data from 95 749 patients enrolled from February 2003 to September 2006 at 484 sites in the CRUSADE registry were analysed. Patients were categorized as having prior 0, 1, 2, or 3 affected arterial beds. The rates of in-hospital mortality, myocardial infarction, stroke, and congestive heart failure were analysed, as were the rates of non-bypass surgery-related red blood cell transfusion and major bleeding. On presentation, 11,345 (11.9%) patients had established PAD, 9973 (10.4%) had documented CVD, and 41,404 (43.2%) had prior CAD. In this cohort, 0, 1, 2, and 3 arterial bed disease before presentation was present in 46 814 (48.9%, 95% CI 48.6-49.2%), 36 704 (38.3%, 95% CI 37.8-39.0%), 10 675 (11.2%, 95% CI 10.9-11.9%), and 1556 (1.6%, 95% CI 1.5-1.8%) patients, respectively. The rates of ischaemic events increased with the number of affected vascular beds. The adjusted odds ratio for the composite of in-hospital ischaemic events for pre-existent disease in 1, 2, or 3 arterial beds (compared with 0 arterial bed involvement) increased from 1.07 to 1.26 to 1.31 (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), although the adjusted rates of protocol-defined non-bypass surgery-related major bleeding did not.
Prior polyvascular disease increases the risk of in-hospital adverse events, including mortality. Identification of these patients in clinical trial and real world populations may provide an opportunity to reduce their excess risk with intensive secondary prevention efforts.
外周动脉疾病（PAD）或脑血管疾病（CVD）的存在与更高的严重冠状动脉疾病（CAD）可能性相关。我们旨在评估患有非 ST 段抬高急性冠状动脉综合征患者中多动脉区域（“多血管”疾病）中存在的 PAD、CVD、先前 CAD 或预先存在的疾病的患病率，及其对不良事件的影响。
对 2003 年 2 月至 2006 年 9 月在 CRUSADE 注册研究的 484 个地点登记的 95749 例患者的数据进行了分析。患者分为 0、1、2 或 3 个受累动脉床。分析了住院期间死亡率、心肌梗死、卒中和充血性心力衰竭的发生率，以及非旁路手术相关的红细胞输血和主要出血的发生率。在就诊时，11345 例（11.9%）患者存在已确诊的 PAD，9973 例（10.4%）患者存在记录在案的 CVD，41404 例（43.2%）患者存在先前的 CAD。在该队列中，就诊前存在 0、1、2 和 3 个动脉床疾病的患者分别为 46814 例（48.9%，95%CI 48.6-49.2%）、36704 例（38.3%，95%CI 37.8-39.0%）、10675 例（11.2%，95%CI 10.9-11.9%）和 1556 例（1.6%，95%CI 1.5-1.8%）。缺血性事件的发生率随受累血管床数量的增加而增加。与 0 个动脉床受累相比，1、2 或 3 个动脉床存在先前疾病的复合住院期间缺血性事件的调整比值比从 1.07 增加到 1.26 再增加到 1.31（P<0.001）。同样，随着疾病负担的增加，输血的调整比值比也从 1.11 增加到 1.28 再增加到 1.30（P<0.001），尽管协议定义的非旁路手术相关主要出血的调整发生率没有增加。
先前的多血管疾病增加了住院期间不良事件的风险，包括死亡率。在临床试验和真实世界人群中识别这些患者可能为通过强化二级预防措施来降低其过度风险提供机会。
