Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease

Leonardo De Luca, Giuseppe Di Pasquale, Lucio Gonzini, Francesco Chiarella, Antonio Di Chiara, Alessandro Boccanelli, Gianni Casella, Zoran Olivari, Stefano De Servi, Michele Massimo Gulizia, Andrea Di Lenarda, Stefano Savonitto, Leonardo Bolognese

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS) and peripheral arterial disease (PAD) present a worse prognosis compared to those without PAD. We sought to describe contemporary trends of in-hospital management and outcome of patients admitted for NSTE-ACS with associated PAD. Methods: We analyzed data from 6 Italian nationwide registries, conducted between 2001 and 2014, including consecutive NSTE-ACS patients. Results: Out of 15,867 patients with NSTE-ACS enrolled in the 6 registries, 2226 (14.0%) had a history of PAD. As compared to non-PAD patients, those with PAD had significantly more risk factors and comorbidities (all p < 0.0001) that increased over time. Patients with PAD underwent less frequently coronary angiography (72.0% vs 79.2%, p < 0.0001) and percutaneous coronary intervention (PCI, 42.9% vs 51.8%, p < 0.0001), compared to patients without PAD. Over the years, a progressive and similar increase occurred in the rates of invasive procedures both in patients with and without PAD (both p for trend <0.0001). The crude in-hospital mortality rate did not significantly change over time (p for trend = 0.83). However, as compared to 2001, the risk of death was significantly lower in all other studies performed at different times, after adjustment for multiple comorbidities. At multivariable analysis, PAD on admission was an independent predictor of in-hospital mortality [odds ratio (OR): 1.75; 95% confidence intervals (CI): 1.35–2.27; p < 0.0001]. Conclusions: Over the 14 years of observation, patients with PAD and NSTE-ACS exhibited worsening baseline characteristics and a progressive increase in invasive procedures. Whereas crude in-hospital mortality did not change over time, we observed a significant reduction in comorbidity-adjusted mortality, as compared to 2001.

Original languageEnglish
Pages (from-to)70-76
Number of pages7
JournalEuropean Journal of Internal Medicine
Volume59
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Peripheral Arterial Disease
Acute Coronary Syndrome
Hospital Mortality
Comorbidity
Registries
Mortality
Percutaneous Coronary Intervention
Coronary Angiography
Odds Ratio
Observation
Confidence Intervals

Keywords

  • Acute coronary syndromes
  • Epidemiology
  • Peripheral arterial disease
  • Registries

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease. / De Luca, Leonardo; Di Pasquale, Giuseppe; Gonzini, Lucio; Chiarella, Francesco; Di Chiara, Antonio; Boccanelli, Alessandro; Casella, Gianni; Olivari, Zoran; De Servi, Stefano; Gulizia, Michele Massimo; Di Lenarda, Andrea; Savonitto, Stefano; Bolognese, Leonardo.

In: European Journal of Internal Medicine, Vol. 59, 01.01.2019, p. 70-76.

Research output: Contribution to journalArticle

De Luca, L, Di Pasquale, G, Gonzini, L, Chiarella, F, Di Chiara, A, Boccanelli, A, Casella, G, Olivari, Z, De Servi, S, Gulizia, MM, Di Lenarda, A, Savonitto, S & Bolognese, L 2019, 'Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease', European Journal of Internal Medicine, vol. 59, pp. 70-76. https://doi.org/10.1016/j.ejim.2018.08.010
De Luca, Leonardo ; Di Pasquale, Giuseppe ; Gonzini, Lucio ; Chiarella, Francesco ; Di Chiara, Antonio ; Boccanelli, Alessandro ; Casella, Gianni ; Olivari, Zoran ; De Servi, Stefano ; Gulizia, Michele Massimo ; Di Lenarda, Andrea ; Savonitto, Stefano ; Bolognese, Leonardo. / Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease. In: European Journal of Internal Medicine. 2019 ; Vol. 59. pp. 70-76.
@article{f6753a71e476429ba610e7f2e4fd2abc,
title = "Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease",
abstract = "Objective: Patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS) and peripheral arterial disease (PAD) present a worse prognosis compared to those without PAD. We sought to describe contemporary trends of in-hospital management and outcome of patients admitted for NSTE-ACS with associated PAD. Methods: We analyzed data from 6 Italian nationwide registries, conducted between 2001 and 2014, including consecutive NSTE-ACS patients. Results: Out of 15,867 patients with NSTE-ACS enrolled in the 6 registries, 2226 (14.0{\%}) had a history of PAD. As compared to non-PAD patients, those with PAD had significantly more risk factors and comorbidities (all p < 0.0001) that increased over time. Patients with PAD underwent less frequently coronary angiography (72.0{\%} vs 79.2{\%}, p < 0.0001) and percutaneous coronary intervention (PCI, 42.9{\%} vs 51.8{\%}, p < 0.0001), compared to patients without PAD. Over the years, a progressive and similar increase occurred in the rates of invasive procedures both in patients with and without PAD (both p for trend <0.0001). The crude in-hospital mortality rate did not significantly change over time (p for trend = 0.83). However, as compared to 2001, the risk of death was significantly lower in all other studies performed at different times, after adjustment for multiple comorbidities. At multivariable analysis, PAD on admission was an independent predictor of in-hospital mortality [odds ratio (OR): 1.75; 95{\%} confidence intervals (CI): 1.35–2.27; p < 0.0001]. Conclusions: Over the 14 years of observation, patients with PAD and NSTE-ACS exhibited worsening baseline characteristics and a progressive increase in invasive procedures. Whereas crude in-hospital mortality did not change over time, we observed a significant reduction in comorbidity-adjusted mortality, as compared to 2001.",
keywords = "Acute coronary syndromes, Epidemiology, Peripheral arterial disease, Registries",
author = "{De Luca}, Leonardo and {Di Pasquale}, Giuseppe and Lucio Gonzini and Francesco Chiarella and {Di Chiara}, Antonio and Alessandro Boccanelli and Gianni Casella and Zoran Olivari and {De Servi}, Stefano and Gulizia, {Michele Massimo} and {Di Lenarda}, Andrea and Stefano Savonitto and Leonardo Bolognese",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ejim.2018.08.010",
language = "English",
volume = "59",
pages = "70--76",
journal = "European Journal of Internal Medicine",
issn = "0953-6205",
publisher = "Elsevier B.V.",

}

TY - JOUR

T1 - Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease

AU - De Luca, Leonardo

AU - Di Pasquale, Giuseppe

AU - Gonzini, Lucio

AU - Chiarella, Francesco

AU - Di Chiara, Antonio

AU - Boccanelli, Alessandro

AU - Casella, Gianni

AU - Olivari, Zoran

AU - De Servi, Stefano

AU - Gulizia, Michele Massimo

AU - Di Lenarda, Andrea

AU - Savonitto, Stefano

AU - Bolognese, Leonardo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS) and peripheral arterial disease (PAD) present a worse prognosis compared to those without PAD. We sought to describe contemporary trends of in-hospital management and outcome of patients admitted for NSTE-ACS with associated PAD. Methods: We analyzed data from 6 Italian nationwide registries, conducted between 2001 and 2014, including consecutive NSTE-ACS patients. Results: Out of 15,867 patients with NSTE-ACS enrolled in the 6 registries, 2226 (14.0%) had a history of PAD. As compared to non-PAD patients, those with PAD had significantly more risk factors and comorbidities (all p < 0.0001) that increased over time. Patients with PAD underwent less frequently coronary angiography (72.0% vs 79.2%, p < 0.0001) and percutaneous coronary intervention (PCI, 42.9% vs 51.8%, p < 0.0001), compared to patients without PAD. Over the years, a progressive and similar increase occurred in the rates of invasive procedures both in patients with and without PAD (both p for trend <0.0001). The crude in-hospital mortality rate did not significantly change over time (p for trend = 0.83). However, as compared to 2001, the risk of death was significantly lower in all other studies performed at different times, after adjustment for multiple comorbidities. At multivariable analysis, PAD on admission was an independent predictor of in-hospital mortality [odds ratio (OR): 1.75; 95% confidence intervals (CI): 1.35–2.27; p < 0.0001]. Conclusions: Over the 14 years of observation, patients with PAD and NSTE-ACS exhibited worsening baseline characteristics and a progressive increase in invasive procedures. Whereas crude in-hospital mortality did not change over time, we observed a significant reduction in comorbidity-adjusted mortality, as compared to 2001.

AB - Objective: Patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS) and peripheral arterial disease (PAD) present a worse prognosis compared to those without PAD. We sought to describe contemporary trends of in-hospital management and outcome of patients admitted for NSTE-ACS with associated PAD. Methods: We analyzed data from 6 Italian nationwide registries, conducted between 2001 and 2014, including consecutive NSTE-ACS patients. Results: Out of 15,867 patients with NSTE-ACS enrolled in the 6 registries, 2226 (14.0%) had a history of PAD. As compared to non-PAD patients, those with PAD had significantly more risk factors and comorbidities (all p < 0.0001) that increased over time. Patients with PAD underwent less frequently coronary angiography (72.0% vs 79.2%, p < 0.0001) and percutaneous coronary intervention (PCI, 42.9% vs 51.8%, p < 0.0001), compared to patients without PAD. Over the years, a progressive and similar increase occurred in the rates of invasive procedures both in patients with and without PAD (both p for trend <0.0001). The crude in-hospital mortality rate did not significantly change over time (p for trend = 0.83). However, as compared to 2001, the risk of death was significantly lower in all other studies performed at different times, after adjustment for multiple comorbidities. At multivariable analysis, PAD on admission was an independent predictor of in-hospital mortality [odds ratio (OR): 1.75; 95% confidence intervals (CI): 1.35–2.27; p < 0.0001]. Conclusions: Over the 14 years of observation, patients with PAD and NSTE-ACS exhibited worsening baseline characteristics and a progressive increase in invasive procedures. Whereas crude in-hospital mortality did not change over time, we observed a significant reduction in comorbidity-adjusted mortality, as compared to 2001.

KW - Acute coronary syndromes

KW - Epidemiology

KW - Peripheral arterial disease

KW - Registries

UR - http://www.scopus.com/inward/record.url?scp=85059841491&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059841491&partnerID=8YFLogxK

U2 - 10.1016/j.ejim.2018.08.010

DO - 10.1016/j.ejim.2018.08.010

M3 - Article

C2 - 30154039

AN - SCOPUS:85059841491

VL - 59

SP - 70

EP - 76

JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

ER -