Association of peripheral artery disease with treatment and outcomes in acute coronary syndromes.: The Global Registry of Acute Coronary Events (GRACE)

被引:69
作者
Froehlich, James B.
Mukherjee, Debabrata
Avezum, Alvaro
Budaj, Andrzej
Kline-Rogers, Eva M.
Lopez-Sendon, Jose
Allegrone, Jeanna
Eagle, Kim A.
Mehta, Rajendra H.
Goldberg, Robert J.
机构
[1] Univ Massachusetts, Sch Med, Worcester, MA 01655 USA
[2] Univ Michigan Hlth Syst, Ann Arbor, MI USA
[3] Dante Pazzaneste Inst Cardiol, Sao Paulo, Brazil
[4] Grochowski Hosp, Postgrad Med Sch, Warsaw, Poland
[5] Hosp Univ Gregorio Maranon, Madrid, Spain
[6] Duke Univ, Med Ctr, Durham, NC USA
关键词
D O I
10.1016/j.ahj.2005.11.005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background National guidelines recommend the use of secondary prevention modalities for patients with peripheral artery disease (PAD) and coronary artery disease. The effect of prior PAD on the treatment and outcomes of patients with acute coronary syndromes (ACS), however, is not well characterized. The objectives of this study were to assess treatment practices and hospital outcomes in patients with ACS and prior PAD. Methods Data were analyzed from 41,108 patients aged >= 18 years with ACS and enrolled in the large multinational GRACE between 1999 and 2004. Results of the 41,108 patients, 4003 (9.7%) had prior PAD. Patients with PAD were older, more likely to be men, to have a variety of prior comorbidities, and to present with non-ST-segment elevation myocardial infarction and a higher Killip class than patients without PAD. Patients with PAD were less likely to be treated with effective cardiac medications than patients without PAD. At the time of hospital presentation, patients with prior PAD had low rates of use of beneficial cardiac medications, including angiotensin-converting enzyme inhibitors, aspirin, beta-blockers, and lipid-lowering agents. Patients with PAD were significantly more likely to experience the composite hospital end point (death, shock, recurrent angina, stroke) than patients without prior PAD (adjusted OR 1.17; 95% Cl 1.08-1.26). Conclusions Patients with prior PAD received less aggressive treatment with proven cardiac medications during hospitalization for an ACS than patients without PAD. Utilization of beneficial medical therapies in patients with PAD before hospitalization with ACS was also less than optimal. Given the poorer hospital outcomes in patients with PAD, our findings suggest considerable opportunity to improve care for these high-risk patients.
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页码:1123 / 1128
页数:6
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