Department of Medicine, Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
Am J Cardiol. 2010 May 1;105(9):1268-71. doi: 10.1016/j.amjcard.2009.12.043. Epub 2010 Mar 11.
The presence of peripheral arterial disease (PAD) in patients with stable coronary artery disease is associated with an increased long-term risk of death, myocardial infarction, and stroke. However, the effect of PAD on short-term outcomes in patients with acute myocardial infarction is less well understood. A total of 9,015 consecutive patients with acute myocardial infarction from the New York State Coronary Angioplasty Reporting System database, all of whom had undergone primary percutaneous coronary intervention in 1998 and 1999, were analyzed. The diagnosis of PAD was determined by a history of aortoiliac, femoral-popliteal, or carotid disease. A logistic regression model was used to determine the relation between PAD and in-hospital death and major adverse cardiovascular events, which included a composite of death, recurrent myocardial infarction, stroke, acute vessel occlusion, stent thrombosis, emergency coronary artery bypass surgery, and vascular injury. PAD had been diagnosed in 529 (5.9%) of the 9,015 patients. Patients with PAD had greater rates of diabetes mellitus, hypertension, and chronic kidney disease and were significantly more likely to develop heart failure, cardiogenic shock, and hemodynamic instability. The incidence of major adverse cardiovascular events was significantly greater in patients with PAD than in patients without PAD (20.4% vs 7.0%, p <0.001). Similarly, the in-hospital mortality rate was significantly greater among the patients with PAD (13% vs 3.8%, p <0.001). After adjusting for the baseline and procedural characteristics, PAD remained an independent predictor of in-hospital mortality (odds ratio 2.2, 95% confidence interval 1.7 to 3.0, p <0.001). In conclusion, PAD was independently associated with a doubling of the in-hospital mortality risk among patients undergoing primary percutaneous coronary intervention for acute myocardial infarction.
患有稳定型冠状动脉疾病的患者若同时患有外周动脉疾病（PAD），其长期死亡、心肌梗死和中风的风险会增加。然而，PAD 对急性心肌梗死患者的短期预后的影响却知之甚少。分析了来自纽约州冠状动脉血管成形术报告系统数据库的 9015 例连续急性心肌梗死患者，这些患者均于 1998 年和 1999 年接受了经皮冠状动脉介入治疗。PAD 的诊断是通过病史确定的，包括主髂动脉、股腘或颈动脉疾病。采用逻辑回归模型确定 PAD 与住院期间死亡和主要不良心血管事件（包括死亡、复发性心肌梗死、中风、急性血管闭塞、支架血栓形成、紧急冠状动脉旁路手术和血管损伤的复合事件）之间的关系。在 9015 例患者中，有 529 例（5.9%）诊断为 PAD。患有 PAD 的患者糖尿病、高血压和慢性肾脏病的发病率更高，发生心力衰竭、心源性休克和血流动力学不稳定的可能性明显更大。与无 PAD 的患者相比，有 PAD 的患者发生主要不良心血管事件的发生率明显更高（20.4% vs. 7.0%，p <0.001）。同样，PAD 患者的住院死亡率也明显更高（13% vs. 3.8%，p <0.001）。在校正了基线和手术特征后，PAD 仍然是住院死亡率的独立预测因素（比值比 2.2，95%置信区间 1.7 至 3.0，p <0.001）。总之，在接受经皮冠状动脉介入治疗的急性心肌梗死患者中，PAD 与住院死亡率风险增加两倍独立相关。
