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Impact of previous vascular burden on in-hospital and long-term mortality in patients with ST-segment elevation
Luciano Consuegra-Sánchez1, Antonio Melgarejo-Moreno2, José Galcerá-Tomás3
1Servicio de Cardiología, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
Insights
Patients with prior vascular disease face higher long-term mortality after ST-segment elevation myocardial infarction. Previous cerebrovascular disease and peripheral arterial disease specifically predict long-term death risk.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Outcomes Research
Background:
- Patients with acute coronary syndrome and prior vascular conditions (ischemic heart disease, peripheral arterial disease, cerebrovascular disease) often have poorer outcomes.
- The long-term impact of these pre-existing vascular conditions on mortality following ST-segment elevation myocardial infarction (STEMI) requires further investigation.
Purpose of the Study:
- To evaluate the association between a history of vascular disease and both in-hospital and long-term mortality in patients with STEMI.
- To determine if specific prior vascular conditions independently predict mortality after STEMI.
Main Methods:
- Prospective observational study of 4247 patients diagnosed with ST-segment elevation myocardial infarction.
- Collection of detailed clinical data, including previous ischemic heart disease, peripheral arterial disease, and cerebrovascular disease (termed "vascular burden").
- Multivariate regression models were used to assess predictors of in-hospital and long-term (median 7.2 years) all-cause mortality.
Main Results:
- A history of prior vascular disease did not independently predict in-hospital mortality.
- Previous cerebrovascular disease (HR=1.57, P<.001) and peripheral arterial disease (HR=1.34, P=.001) were significant independent predictors of long-term mortality.
- Patients with disease in two or more vascular territories had significantly higher long-term mortality (HR=2.35, P<.001) but not in-hospital mortality.
Conclusions:
- In patients with ST-segment elevation myocardial infarction, a pre-existing "vascular burden" significantly increases long-term mortality.
- Previous cerebrovascular disease and peripheral arterial disease are identified as key independent predictors of mortality following hospital discharge for STEMI.
Introduction And Objectives:
Patients with a current acute coronary syndrome and previous ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease are reported to have a poorer outcome than those without these previous conditions. It is uncertain whether this association with outcome is observed at long-term follow-up.
Methods:
Prospective observational study, including 4247 patients with ST-segment elevation myocardial infarction. Detailed clinical data and information on previous ischemic heart disease, peripheral arterial disease, and cerebrovascular disease ("vascular burden") were recorded. Multivariate models were performed for in-hospital and long-term (median, 7.2 years) all-cause mortality.
Results:
One vascular territory was affected in 1131 (26.6%) patients and ≥ 2 territories in 221 (5.2%). The total in-hospital mortality rate was 12.3% and the long-term incidence density was 3.5 deaths per 100 patient-years. A background of previous ischemic heart disease (odds ratio = 0.83; P = .35), peripheral arterial disease (odds ratio = 1.30; P = .34), or cerebrovascular disease (stroke) (odds ratio = 1.15; P = .59) was not independently predictive of in-hospital death. In an adjusted model, previous cerebrovascular disease and previous peripheral arterial disease were both predictors of mortality at long-term follow-up (hazard ratio = 1.57; P < .001; and hazard ratio = 1.34; P = .001; respectively). Patients with ≥ 2 diseased vascular territories showed higher long-term mortality (hazard ratio = 2.35; P < .001), but not higher in-hospital mortality (odds ratio = 1.07; P = .844).
Conclusions:
In patients with a diagnosis of ST-segment elevation acute myocardial infarction, the previous vascular burden determines greater long-term mortality. Considered individually, previous cerebrovascular disease and peripheral arterial disease were predictors of mortality at long-term after hospital discharge.
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