Peripheral artery disease and outcomes after myocardial infarction: an individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT

Inglis, S.C. et al. (2013) Peripheral artery disease and outcomes after myocardial infarction: an individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT. International Journal of Cardiology, 168(2), pp. 1094-1101. (doi:10.1016/j.ijcard.2012.11.033)

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Abstract

Objectives: To examine the prevalence of peripheral artery disease (PAD) and the relationship between PAD and cardiovascular (CV) outcomes in subjects with left ventricular systolic dysfunction, heart failure or both after acute myocardial infarction (MI).

Background: PAD is associated with poorer prognosis in patients with stable and unstable coronary heart disease but whether PAD is associated with worse outcomes following substantial acute MI is unknown.

Methods: Univariate and multivariate Cox proportional hazards modelling was used to compare clinical outcomes in an individual-patient meta-analysis of 4 trials (CAPRICORN, EPHESUS, OPTIMAAL and VALIANT).

Results: Of the 28,771 patients randomized, 2357 (8.2%) had PAD. These patients were older and had more co-morbidity and were less likely to be prescribed aspirin or a beta-blocker compared to patients without PAD. Over a mean follow-up of 2.7 years, 5121 (17.8%) patients died and 15,055 (52.3%) experienced CV death or hospitalization. PAD was an independent predictor of all individual and composite CV outcomes examined (including heart failure), with the exception of stroke. In patients with PAD (compared to those without PAD), the adjusted hazard ratio (HR) for all-cause mortality was 1.25 (95% CI 1.15–1.37; p < 0.001) and the HR for CV death, non-fatal MI, non-fatal stroke or heart failure hospitalization was 1.24 (1.16–1.33; p < 0.001). Conclusions: PAD is common and is an independent predictor of worse outcomes in patients already at high risk after MI because of left ventricular systolic dysfunction, heart failure or both. These patients represent an important group for intensive application of secondary preventive therapies.

Abbreviations: ACE, Angiotensin-converting-enzyme; CAPRICORN, Carvedilol on Outcome after Myocardial Infarction in Patients with Left Ventricular Dysfunction trial; CV, Cardiovascular; EPHESUS, Eplerenone's Neurohormonal Efficacy and Survival Study; HF, Heart failure; HR, Hazard ratio; MI, Myocardial Infarction; OPTIMAAL, Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan; PAD, Peripheral artery disease; VALIANT, Valsartan in Acute Myocardial Infarction trial.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John and Ford, Professor Ian and Dargie, Professor Henry and Inglis, Dr Sally
Authors: Inglis, S.C., Bebchuk, J., Al-Suhaim, S.A., Case, J., Pfeffer, M.A., Solomon, S.D., Hou, Y., Pitt, B., Dargie, H.J., Ford, I., Kjekshus, J., Zannad, F., Dickstein, K., and McMurray, J.J.V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:International Journal of Cardiology
Publisher:Elsevier Science B.V., Amsterdam.
ISSN:0167-5273
ISSN (Online):1874-1754

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