Riassunto analitico
INTRODUCTION: Acute coronary syndromes (ACS) represent the leading cause of mortality worldwide and, despite the wide choice of secondary prevention therapies, is still burdened by substantial residual cardiovascular (CV) risk even in the subsequent 12 months. In this contest , while peripheral artery disease (PAD) has been associated with increased major adverse cardiovascular events (MACE), the impact of subclinical PAD (sPAD) is still debated.
AIMS OF THE STUDY The present study aims to assess the role of sPAD in a real-world cohort of ACS-patients on all-cause mortality. We also investigated major adverse cardiac events (MACE), a composite endpoint of all-cause mortality and myocardial infarction.
MATERIALS AND METHODS Consecutive patients from the ACS-Modena Database, admitted to the Cardiology Department of Modena University Hospital since April 2020 for ACS were enrolled in this research. Subjects unable to give informed consent or with life-expectance less than one year were excluded. sPAD was assessed through a modified Edimburgh’s questionnaire and patients were divided in two groups according to the presence of typical claudicatio. The primary endpoint was long-term all-cause mortality.
RESULTS Out of 84 patients presenting with ACS, 29.8% (n=25) had a history of sPAD; of these 28.0% aged ≥ 75 years. Patients with sPAD, compared to those without sPAD had a higher prevalence of traditional risk factors such as dyslipidemia (84.0% vs 61.9%, p<0.048), whereas no significant differences have been observed in smoke habit. Patients with sPAD presented also significantly higher levels of baseline glucose (178.1±142.4 mg/dl vs 112.0±28.6 mg/dl
2
p=0.037). No differences in term of ECG presentation and medical treatment were detected, both at baseline as at discharge, except for an increase numerical rate of anti-thrombotic (clopidogrel 20.8% vs 12.8%, p=ns) and lipid-lowering therapies (statins 58.3% vs 52.2%, p=ns). The median FU was 204 days (104-337, IQrange 233). All cause of death was significantly higher in sPAD patients (20.0% vs. 2.4% p=0.024), with a numerical increase in non-fatal MI (8.0% vs. 2.4%, p=ns). In a multivariate regression model, dyslipidemia (p=0.015) and sPAD (p=0.011) remained significant predictors of all-cause of death.
CONCLUSION In real-word ACS-patients, concomitant sPAD is associated with a significantly higher risk of all-cause of death and MACE, compared to patients without sPAD. Despite the higher CV risk, patients with sPAD did not differ in term of secondary preventive therapies. sPAD may therefore be useful in further stratifying high-risk patients, individualizing secondary prevention therapies and follow-up. The results of our study, due to the several limitations, have to be confirmed in larger and dedicated investigations.
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