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Impact of pre-existing vascular disease on clinical outcomes

Weight, Nicholas; Moledina, Saadiq; Zoccai, Giuseppe Biondi; Zaman, Sarah; Smith, Triston; Siller-Matula, Jolanta; Dafaalla, Mohamed; Rashid, Muhammad; Nolan, James; Mamas, Mamas A.

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Authors

Nicholas Weight

Saadiq Moledina

Giuseppe Biondi Zoccai

Sarah Zaman

Triston Smith

Jolanta Siller-Matula

Mohamed Dafaalla



Abstract

AIMS: Little is known about the outcomes and processes of care of patients with non ST-segment myocardial infarction (NSTEMI) who present with 'polyvascular' disease. METHODS AND RESULTS: We analysed 287,279 NSTEMI patients using the Myocardial Infarction National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analysed according to history of affected vascular bed; coronary artery disease (CAD), cerebrovascular disease (CeVD) and peripheral vascular disease (PVD), with comparison to a historically disease-free control group; comprising 167,947 patients (59%). After adjusting for demographics and management, polyvascular disease was associated with increased likelihood of major adverse cardiovascular events (MACE) (CAD OR: 1.06, 95% CI: 1.01-1.12, P = 0.02) (CeVD OR: 1.19, 95% CI: 1.12-1.27, P<0.001) (PVD OR: 1.22, 95% CI: 1.13-1.33, P<0.001) and in-hospital mortality (CeVD OR: 1.24, 95% CI: 1.16-1.32, P<0.001) (PVD OR: 1.33, 95% CI: 1.21-1.46, P<0.001). Patients without vascular disease were less frequently discharged on statins (PVD 88%, CeVD 86%, CAD 90% and control 78%), and those with moderate (ejection fraction (EF) 30-49%) or severe left ventricular systolic dysfunction (LVSD) (EF<30%), were less frequently discharged on angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) (CAD 82%, CeVD 77%, PVD 77%, control 74%). Patients with polyvascular disease were less likely to be discharged on dual antiplatelet therapy (DAPT) (PVD 78%, CeVD 77%, CAD 80%, control 87%). CONCLUSION: Polyvascular disease patients had a higher incidence of in-hospital mortality and MACE. Patients with no history of vascular disease were less likely to receive statins or ACE inhibitors/ARBs, but more likely to receive DAPT.

Journal Article Type Article
Acceptance Date May 16, 2022
Publication Date May 16, 2022
Publicly Available Date Jun 20, 2023
Journal European Heart Journal - Quality of Care and Clinical Outcomes
Print ISSN 2058-5225
Publisher Oxford University Press
DOI https://doi.org/10.1093/ehjqcco/qcac026
Publisher URL https://academic.oup.com/ehjqcco/advance-article-abstract/doi/10.1093/ehjqcco/qcac026/6586339?redirectedFrom=fulltext

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