Mureddu Gian Francesco, Rosato Stefano, D'Errigo Paola, Faggiano Pompilio, Ciccarelli Paola, Badoni Gabriella, Ambrosetti Marco, Fattirolli Francesco, Baglio Giovanni
Cardiac Rehabilitation Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy.
ITACARE-P (Italian Alliance for Cardiovascular Rehabilitation and Prevention), 21100 Varese, Italy.
J Clin Med. 2025 Jun 11;14(12):4158. doi: 10.3390/jcm14124158.
: Atherothrombosis is a systemic disease that may affect one or more than one vascular bed. Data on the impact of polyvascular disease (PVD) on the long-term prognosis of patients with coronary artery disease (CAD) are still scarce. Aim: To assess the prevalence of symptomatic PVD in a cohort of patients with a new episode of acute coronary syndrome (ACS) and to investigate the impact of multiple vascular beds involvement on long-term outcomes. : We analysed a nationwide, comprehensive administrative database of consecutive patients aged ≥ 40 years admitted for a new episode of ACS in Italy in 2017-2018. Patients with ACS were stratified according to the presence of peripheral artery disease (PAD) only; cerebrovascular disease (CeVD) only; PAD+CeVD; or neither (no PAD/noCeVD, i.e., ACS only). A multivariate Cox proportional hazards model was used to assess the impact of PAD only; CeVD only and PAD+CeVD on 5-year MACCE. : A total of 342,052 patients hospitalised with ACS were identified. Among them, 24,727 (7.2%) were patients with PAD only, 16,887 (4.9%) with CeVD only, and 5810 (1.7%) with PAD+CeVD. After adjusting for age, sex, and comorbidities, the hazard ratio (HR) for 5-year MACCE was 1.37 (95% CI: 1.35-1.40), 1.36 (95% CI: 1.33-1.39), and 1.45 (95% CI: 1.40-1.50) in patients with PAD only, CeVD only, and PAD+CeVD, respectively, compared with patients with ACS only. : In patients with ACS, the involvement of a second vascular bed increases the risk of long-term outcomes; the simultaneous involvement of three vascular beds further increases the risk of long-term outcomes.
动脉粥样硬化血栓形成是一种全身性疾病，可能影响一个或多个血管床。关于多血管疾病（PVD）对冠状动脉疾病（CAD）患者长期预后影响的数据仍然很少。目的：评估急性冠状动脉综合征（ACS）新发患者队列中有症状PVD的患病率，并研究多血管床受累对长期预后的影响。：我们分析了2017 - 2018年意大利全国范围内连续收治的≥40岁ACS新发患者的综合管理数据库。ACS患者仅根据外周动脉疾病（PAD）的存在情况进行分层；仅脑血管疾病（CeVD）；PAD + CeVD；或两者都无（无PAD /无CeVD，即仅ACS）。使用多变量Cox比例风险模型评估仅PAD；仅CeVD和PAD + CeVD对5年主要不良心血管和脑血管事件（MACCE）的影响。：共确定了342,052例因ACS住院的患者。其中，仅PAD患者24,727例（7.2%），仅CeVD患者16,887例（4.9%），PAD + CeVD患者5810例（1.7%）。在调整年龄、性别和合并症后，仅PAD、仅CeVD和PAD + CeVD患者5年MACCE的风险比（HR）分别为1.37（95%置信区间：1.35 - 1.40）、1.36（95%置信区间：1.33 - 1.39）和1.45（95%置信区间：1.40 - 1.50），与仅ACS患者相比。：在ACS患者中，第二个血管床受累会增加长期预后风险；三个血管床同时受累会进一步增加长期预后风险。
