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Acute Coronary Syndrome: Disparities of Pathophysiology and Mortality with and without Peripheral Artery Disease

Flavius-Alexandru Gherasie1, Mihaela-Roxana Popescu1,2, Daniela Bartos1,3

  • 1Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania.

Journal of Personalized Medicine
|June 28, 2023
PubMed

Insights

Peripheral artery disease and acute coronary syndrome share thrombosis but differ in cause and mortality. Differentiating these atherosclerotic conditions is crucial for effective management and improved patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Biology
  • Atherosclerosis Research

Background:

  • Peripheral artery disease (PAD) and coronary artery disease (CAD) share common risk factors but exhibit distinct pathophysiological mechanisms and clinical outcomes.
  • Thrombosis is a key feature in both PAD and CAD, yet its underlying causes, such as plaque rupture in CAD versus calcified nodules in PAD, differ significantly.
  • Patients with PAD, particularly those experiencing acute limb ischemia, often present with thrombi unrelated to significant atherosclerotic burden, suggesting diverse etiologies.

Purpose of the Study:

  • To investigate the disparities in pathophysiology and mortality between acute coronary syndrome (ACS) with and without coexisting peripheral artery disease (PAD).
  • To synthesize existing literature comparing the mechanisms of thrombosis in PAD and ACS.
  • To highlight the differential impact of these conditions on cardiovascular mortality.

Main Methods:

  • Systematic review of published data comparing ACS and PAD.
  • Analysis of studies focusing on the etiological factors of thrombosis in peripheral versus coronary arteries.
  • Comparative analysis of cardiovascular mortality rates in patients with and without PAD and/or myocardial infarction/stroke.

Main Results:

  • Thrombosis in PAD, especially in above-knee arteries, is frequently linked to calcified nodules, a less common cause of luminal thrombosis in ACS.
  • A significant proportion of acute limb ischemia cases in PAD are associated with minimal atherosclerosis, indicating non-atherosclerotic thrombotic triggers.
  • Cardiovascular mortality is notably higher in patients with PAD but without myocardial infarction or stroke, compared to those with myocardial infarction or stroke but without PAD.

Conclusions:

  • Acute coronary syndrome and peripheral artery disease, while both involving thrombosis, possess distinct pathophysiological underpinnings.
  • The differing mechanisms of thrombosis in PAD and ACS necessitate tailored diagnostic and therapeutic strategies.
  • Understanding these disparities is critical for improving risk stratification and reducing cardiovascular mortality in patients with atherosclerotic vascular disease.

Keywords:
acute coronary syndromeacute limb ischemiaankle-brachial indexatherosclerosischronic limb-threatening ischemiacoronary artery diseaseinflammationnodule calcificationperipheral artery diseaseplaque erosion

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