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Incremental prognostic value of coronary and systemic atherosclerosis after myocardial infarction
Department of Cardiology, Örebro University Hospital, Örebro, Sweden; Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Department of Cardiology, Örebro, Sweden; , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Centre for Clinical Research, Uppsala University, Uppsala, Sweden; Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden.
Centre for Clinical Research, Uppsala University Västmanland County Hospital, Västerås, Sweden.
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 261, p. 6-11Article in journal (Refereed) Published
Abstract [en]

Background: The role of systemic atherosclerosis in myocardial infarction (MI) patients is not fully understood. We investigated the incremental prognostic value of coronary and systemic atherosclerosis after acute MI by estimating extra-cardiac artery disease (ECAD) and extent of coronary atherosclerosis.

Methods and results: The study included 544 prospective MI patients undergoing coronary angiography. For all patients, the longitudinal coronary atherosclerotic extent, expressed as Sullivan extent score (SES) was calculated. In addition, the patients underwent non-invasive screening for ECAD in the carotid, aortic, renal and lower limb. SES was found to be associated with ECAD independent of baseline clinical parameters [adjusted odds ratio (OR) 1.04 95% confidence interval (CI) 1.02-1.06, P < 0.001]. Extensive systemic atherosclerosis, defined as the combination of extensive coronary disease (SES >= 17) and ECAD, was associated with higher risk for all-cause mortality compared to limited systemic atherosclerosis (SES < 17 and no ECAD) (hazard ratio [HR] 2.9 95% CI 1.9-4.5, P < 0.001, adjusted for Global Registry of Acute Coronary Events risk score parameters 1.8, 95% CI 1.1-3.0, P = 0.019). The risk for the composite endpoint of cardiovascular death or hospitalization was significantly higher in patients with extensive systemic atherosclerosis compared to patients with limited systemic atherosclerosis (HR 3.1, 95% CI 2.1-4.7, P < 0.001, adjusted HR 1.9, 95% CI 1.2-3.1, P < 0.004).

Conclusions: Visual estimation of the longitudinal coronary atherosclerotic extent at the time of MI predicts ECAD. Coexistence of extensive coronary disease and ECAD defines a group with particularly poor prognosis after MI.

Place, publisher, year, edition, pages
Elsevier , 2018. Vol. 261, p. 6-11
Keywords [en]
Atherosclerosis, Myocardial infarction, Coronary artery disease, Extra-cardiac artery disease, Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-66830DOI: 10.1016/j.ijcard.2018.02.035ISI: 000430081000002PubMedID: 29657058Scopus ID: 2-s2.0-85045428710OAI: oai:DiVA.org:oru-66830DiVA, id: diva2:1203169
Note

Funding Agencies:

Sparbanksstiftelsen Nya  552  693  0932  2297 

Collaboration fund (Counties of Örebro, Västmanland, and Sörmland)  10OLL1951 

Research committee (Örebro County council)  OLL-135611  OLL-202161 

Uppsala/Örebro Regional Research Council  RFR-641271 

Available from: 2018-05-02 Created: 2018-05-02 Last updated: 2018-09-14Bibliographically approved

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