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Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction
Faculty of Health, Department of Cardiology, Orebro University, Sweden.
Örebro University, School of Medical Sciences. Department of Cardiology.ORCID iD: 0000-0002-9821-0510
Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden.
Örebro University, School of Medical Sciences. Department of Cardiology.
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2017 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 263, 53-59 p.Article in journal (Refereed) Published
Abstract [en]

Background and aims: In patients with coronary artery disease (CAD), clinically overt extracoronary artery diseases (ECADs), including claudication or previous strokes, are associated with poor outcomes. Subclinical ECADs detected by screening are common among such patients. We aimed to evaluate the prognostic impact of subclinical versus symptomatic ECADs in patients with acute myocardial infarction (AMI).

Methods: In a prospective observational study, 654 consecutive patients diagnosed with AMI underwent ankle brachial index (ABI) measurements and ultrasonographic screening of the carotid arteries and abdominal aorta. Clinical ECADs were defined as prior strokes, claudication, or extracoronary artery intervention. Subclinical ECADs were defined as the absence of a clinical ECAD in combination with an ABI <= 0.9 or >1.4, carotid artery stenosis, or an abdominal aortic aneurysm.

Results: At baseline, subclinical and clinical ECADs were prevalent in 21.6% and 14.4% of the patients, respectively. Patients with ECADs received evidence-based medication more often at admission but similar medications at discharge compared with patients without ECADs. During a median follow-up of 5.2 years, 166 patients experienced endpoints of hospitalization for AMI, heart failure, stroke, or cardiovascular death. With ECAD-free cases as reference and after adjustment for risk factors, a clinical ECAD (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.34-3.27, p = 0.001), but not a subclinical ECAD (HR 1.35, 95% CI 0.89-2.05, p = 0.164), was significantly associated with worse outcomes.

Conclusions: Despite receiving similar evidence-based medication at discharge, patients with clinical ECAD, but not patients with a subclinical ECAD, had worse long-term prognosis than patients without an ECAD after AMI. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 263, 53-59 p.
Keyword [en]
Extracoronary artery disease, Myocardial infarction, Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-60724DOI: 10.1016/j.atherosclerosis.2017.05.027ISI: 000407634000884PubMedID: 28599258Scopus ID: 2-s2.0-85020304353OAI: oai:DiVA.org:oru-60724DiVA: diva2:1140168
Note

Funding Agencies:

Sparbanksstiftelsen Nya  552  693  0932  2297 

County of Västmanland  

Swedish Medical Association

Available from: 2017-09-11 Created: 2017-09-11 Last updated: 2017-10-10Bibliographically approved

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