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The prognostic value of peripheral artery diseases in patients with ST-segment elevation myocardial infarction

Olga L Barbarash1, Mikhail V Zykov1, Tamara B Pecherina1

  • 1Research Institute for Complex Issues of Cardiovascular Diseases under the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002, Russia ; Department of Cardiology and Cardiovascular Surgery, Kemerovo State Medical Academy, Sosnovy Bulvar 6, Kemerovo 650002, Russia.

Disease Markers
|January 14, 2014
PubMed

Insights

Polyvascular diseases, including extracranial artery (ECA) and lower extremity artery (LEA) stenosis, are common in ST-elevation myocardial infarction (STEMI) patients. Higher stenosis levels (>30%) correlate with increased STEMI mortality, necessitating improved risk stratification.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Clinical Risk Stratification

Background:

  • Polyvascular disease (PVD) is prevalent in ST-segment elevation myocardial infarction (STEMI) patients.
  • Intima-media thickness (IMT) of the common carotid artery or stenosis of extracranial arteries (ECA) or lower extremity arteries (LEA) define PVD.

Purpose of the Study:

  • To assess the clinical and prognostic significance of hemodynamically insignificant stenosis in ECA and LEA in STEMI patients.
  • To develop an improved risk stratification model for STEMI patients.

Main Methods:

  • A cohort of 423 STEMI patients admitted to Kemerovo Cardiological Centre was studied.
  • Prevalence of PVD was determined by IMT or ECA/LEA stenosis.
  • Case fatality rates were compared between stenosis groups (<30% vs. >30%).
  • The GRACE score was enhanced with additional factors to create the KemScore model.

Main Results:

  • PVD prevalence was 95% among STEMI patients.
  • Case fatality was significantly higher in patients with >30% stenosis (15.1%) compared to <30% stenosis (5.7%) (P = 0.003).
  • The developed KemScore model demonstrated superior predictive accuracy (AUC = 0.83) compared to the GRACE score (AUC = 0.71).

Conclusions:

  • Hemodynamically insignificant ECA and LEA stenosis are highly prevalent in STEMI patients and carry prognostic implications.
  • The KemScore model, incorporating PVD and other factors, offers improved 12-month mortality risk stratification for STEMI patients.
Abstract

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