Örebro University, Faculty of Health, Department of Cardiology, Sweden.
Örebro University, Faculty of Health, Department of Cardiology, Sweden.
Atherosclerosis. 2017 Aug;263:53-59. doi: 10.1016/j.atherosclerosis.2017.05.027. Epub 2017 May 26.
In patients with coronary artery disease (CAD), clinically overt extracoronary artery diseases (ECADs), including claudication or previous strokes, are associated with poor outcomes. Subclinical ECADs detected by screening are common among such patients. We aimed to evaluate the prognostic impact of subclinical versus symptomatic ECADs in patients with acute myocardial infarction (AMI).
In a prospective observational study, 654 consecutive patients diagnosed with AMI underwent ankle brachial index (ABI) measurements and ultrasonographic screening of the carotid arteries and abdominal aorta. Clinical ECADs were defined as prior strokes, claudication, or extracoronary artery intervention. Subclinical ECADs were defined as the absence of a clinical ECAD in combination with an ABI ≤0.9 or >1.4, carotid artery stenosis, or an abdominal aortic aneurysm.
At baseline, subclinical and clinical ECADs were prevalent in 21.6% and 14.4% of the patients, respectively. Patients with ECADs received evidence-based medication more often at admission but similar medications at discharge compared with patients without ECADs. During a median follow-up of 5.2 years, 166 patients experienced endpoints of hospitalization for AMI, heart failure, stroke, or cardiovascular death. With ECAD-free cases as reference and after adjustment for risk factors, a clinical ECAD (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.34-3.27, p=0.001), but not a subclinical ECAD (HR 1.35, 95% CI 0.89-2.05, p=0.164), was significantly associated with worse outcomes.
Despite receiving similar evidence-based medication at discharge, patients with clinical ECAD, but not patients with a subclinical ECAD, had worse long-term prognosis than patients without an ECAD after AMI.
在患有冠状动脉疾病（CAD）的患者中，临床明显的冠状动脉外动脉疾病（ECADs），包括跛行或既往中风，与不良预后相关。通过筛查检测到的亚临床 ECAD 在这些患者中很常见。我们旨在评估亚临床与有症状的 ECAD 在急性心肌梗死（AMI）患者中的预后影响。
在一项前瞻性观察研究中，654 例连续诊断为 AMI 的患者接受了踝臂指数（ABI）测量和颈动脉及腹主动脉的超声筛查。临床 ECAD 定义为既往中风、跛行或冠状动脉外动脉介入。亚临床 ECAD 定义为无临床 ECAD 同时 ABI≤0.9 或>1.4、颈动脉狭窄或腹主动脉瘤。
基线时，亚临床和临床 ECAD 在分别在 21.6%和 14.4%的患者中存在。与无 ECAD 的患者相比，患有 ECAD 的患者在入院时更常接受基于证据的药物治疗，但在出院时接受的药物相同。在中位随访 5.2 年期间，166 例患者经历了 AMI、心力衰竭、中风或心血管死亡的住院终点。以无 ECAD 病例为参考，并在调整了危险因素后，临床 ECAD（风险比 [HR] 2.10，95%置信区间 [CI] 1.34-3.27，p=0.001），但不是亚临床 ECAD（HR 1.35，95% CI 0.89-2.05，p=0.164），与预后较差显著相关。
尽管出院时接受了类似的基于证据的药物治疗，但患有临床 ECAD 的患者，而不是亚临床 ECAD 的患者，在 AMI 后比无 ECAD 的患者具有更差的长期预后。
