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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Incidence, Characteristics, and Outcomes of Myocardial Infarction in Patients With Peripheral Artery Disease:
Christoph B Olivier1, Hillary Mulder2, William R Hiatt3,4
1Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Importance:
Patients with peripheral artery disease (PAD) are at high risk for myocardial infarction (MI).
Objective:
To characterize the incidence and types of MI in a PAD population, identify factors associated with MI, and determine the association of MI with cardiovascular mortality and acute limb ischemia.
Design, Setting, And Participants:
The Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease (EUCLID) was a double-blind randomized clinical trial conducted at 811 sites in 28 countries that randomized 13 885 patients with symptomatic PAD to monotherapy with ticagrelor or clopidogrel. Participants had an ankle-brachial index (ABI) of 0.80 or less or previous lower extremity revascularization. Median follow-up was 30 months. For these analyses, patients were evaluated for MI occurrence during follow-up irrespective of treatment. Data were analyzed from June 2017 to September 2018.
Main Outcomes And Measures:
An adjudication clinical events committee classified MI as type 1 (spontaneous), type 2 (secondary), type 3 (sudden cardiac death), type 4a (less than 48 hours after percutaneous coronary intervention), type 4b (definite stent thrombosis), or type 5 (less than 72 hours after coronary artery bypass graft). A multivariate regression model was developed by stepwise selection to identify factors associated with MI, and a time-dependent multivariate Cox regression analysis was performed to determine the association of MI with cardiovascular death and acute limb ischemia requiring hospitalization.
Results:
Of the 13 885 patients included in this analysis, 9997 (72.0%) were male, and the median (interquartile range) age was 66 (60-73) years. Myocardial infarction occurred in 683 patients (4.9%; 2.4 events per 100 patient-years) during a median follow-up of 30 months. Patients experiencing MI were older (median [interquartile range] age, 69 [62-75] vs 66 [60-72] years), more likely to have diabetes (349 of 683 [51.1%] vs 4996 of 13 202 [37.8%]) or a previous lower extremity revascularization (466 of 683 [68.2%] vs 7409 of 13 202 [56.1%]), and had a lower ABI (if included by ABI) compared with censored patients. Of the 683 patients with MI during follow-up, the most common MI type was type 1 (405 [59.3%]), followed by type 2 (236 [34.6%]), type 4a (14 [2.0%]), type 3 (12 [1.8%]), type 4b (11 [1.6%]), and type 5 (5 [0.7%]). Postrandomization MI was independently associated with cardiovascular death (adjusted hazard ratio, 9.0; 95% CI, 7.3-11.2; P < .001) and acute limb ischemia requiring hospitalization (adjusted hazard ratio, 2.5; 95% CI, 1.3-5.0; P = .008).
Conclusions And Relevance:
Approximately 5% of patients with symptomatic PAD had an MI during a median follow-up of 30 months. Type 1 MI (spontaneous) was the most common MI type; however, one-third of MIs were type 2 MI (secondary). More research is needed to identify therapies to reduce the risk of MI in patients with PAD and to improve management of type 2 MI.
Trial Registration:
ClinicalTrials.gov Identifier: NCT01732822.
Insights
Patients with peripheral artery disease (PAD) experienced myocardial infarction (MI) at a rate of approximately 5% over 30 months. Type 1 MI was most common, but type 2 MI occurred in one-third of cases, highlighting a need for further research.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Clinical Trials
Background:
- Patients with peripheral artery disease (PAD) face a significantly elevated risk of myocardial infarction (MI).
- Understanding MI incidence, types, and associated factors in PAD is crucial for risk stratification and management.
Purpose of the Study:
- To determine the incidence and types of MI in patients with symptomatic PAD.
- To identify factors associated with MI in this population.
- To assess the impact of MI on cardiovascular mortality and acute limb ischemia.
Main Methods:
- The EUCLID trial randomized 13,885 patients with symptomatic PAD to ticagrelor or clopidogrel.
- MI was classified into 6 types (1-5), with adjudication by a clinical events committee.
- Multivariate regression and Cox regression analyses identified risk factors and outcomes associated with MI.
Main Results:
- Myocardial infarction (MI) occurred in 4.9% of patients over a median follow-up of 30 months.
- Patients with MI were older, more likely to have diabetes, and had prior lower extremity revascularization.
- Type 1 MI was most frequent (59.3%), followed by type 2 MI (34.6%).
- MI was independently associated with a 9-fold increased risk of cardiovascular death and a 2.5-fold increased risk of acute limb ischemia.
Conclusions:
- Approximately 5% of patients with symptomatic PAD experienced MI during the study period.
- While spontaneous (type 1) MI was most common, secondary (type 2) MI represented a substantial proportion.
- Further research is warranted to develop targeted therapies for MI prevention and management in PAD patients, particularly for type 2 MI.
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