IMPACT OF POLYVASCULAR DISEASE ON LONG–TERM PROGNOSIS IN PATIENTS WITH ACUTE CORONARY SYNDROME. A PROSPECTIVE COHORT STUDY IN ITALY

Abstract

Abstract Background Atherothrombosis should be considered a systemic disease that may involve one or more than one vascular beds. Data on the impact of polyvascular disease on long–term prognosis in patients with acute coronary syndrome (ACS) are still scarce. Aim To assess the prevalence of symptomatic polyvascular disease in a cohort of patients with ACS and to investigate the impact on long–term outcomes of single versus multiple vascular beds involvement. Methods We analyzed a nationwide, comprehensive, and universal administrative database of consecutive patients older than 40 years admitted for a new episode of ACS in 2013–14 in Italy. Patients with ACS were stratified according to the presence of Peripheral Arterial Disease (PAD) only, Cerebrovascular Disease (CeVD) only, PAD and CeVD (PAD+CeVD) or neither (noPAD/noCeVD). A Cox proportional hazard multivariate model was used to evaluate the impact of PAD only, CeVD only and PAD+CeVD on 5–year MACCE. Results 331320 new episode of ACS were identified. Among them, 24491 (7.4%) were patients with PAD only, 16269 (4.9%) with CeVD only and 4710 (1.4%) with PAD+CeVD. The 5 years MACCE was 42.6%, 64.7%, 66.1 and 72.2 (p<0.001) for noPAD/noCeVD, PAD only, CeVD only and PAD+CeVD, respectivelly. After adjustment for age, sex, and comorbidities, the hazard ratio (HR) for 5–year MACCE was 1.30 (p<0.0001), 1.39 (p<0.0001), and 1.46 (p<0.0001) in patients with PAD only, CeVD only, and PAD+CeVD, respectively, as compared with patients without PAD and CeVD. Conclusion Polyvascular disease represents a major risk factor in patients with ACS. The simultaneous involvement of three vascular beds further increases the risk of long–term outcomes. Greater effort should be directed toward identification of subclinical/clinical atherosclerosis of beds different from coronary for a better risk stratification.