ORLANDO — Polyvascular disease—symptomatic atherosclerotic disease in more than one arterial bed—was a significant risk factor for new cardiovascular events in a review of nearly 100,000 patients with acute coronary syndrome.
“Although the incremental risk [from polyvascular disease] is modest, it's similar to the added risk from diabetes,” Dr. Deepak L. Bhatt said at the annual scientific sessions of the American Heart Association.
“This is a cheap and easy way to further prognosticate risk, and it needs no additional testing,” said Dr. Bhatt, a cardiologist at the Cleveland Clinic. Physicians should also take note of the extra risk posed by polyvascular disease because current data suggest these patients are often, paradoxically, undertreated compared with patients who have documented atherosclerotic disease in just one vascular bed, he said.
The study used data collected on more than 95,000 patients with either unstable angina or non-ST segment elevation myocardial infarction who were enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) registry during February 2003-September 2006 at about 500 U.S. hospitals.
For the new analysis, patients were classified as having prior disease in any of three arterial beds.
Patients were identified with coronary disease if they had a prior myocardial infarction or revascularization procedure, found in 43%. Patients were deemed to have carotid disease if they had a prior stroke, which occurred in 10%. Peripheral arterial disease was identified in patients with a history of any of several markers, including claudication, arterial insufficiency, bypass, or a low ankle/brachial index. A total of 12% had established peripheral arterial disease.
Polyvascular disease was moderately prevalent, with 11% of patients having disease in two arterial beds, and 2% having disease in all three beds. Prior disease in a single bed was identified in 38%, and 49% had no identified diseased bed.
In an analysis that controlled for other variables at the time of hospitalization, patients with two affected beds had a 25% risk of having a cardiovascular event during their hospitalization compared with patients with no diagnosed arterial beds. An event was cardiovascular death, myocardial infarction, stroke, or heart failure.
Patients with three affected beds had a 30% increased risk of an in-hospital event, compared with patients with no diagnosed beds. In contrast, patients identified with one affected bed at hospitalization had a 7% increased risk, compared with patients who had no affected beds. The difference between each of the two polyvascular groups and the univascular group (one affected bed) was statistically significant, Dr. Bhatt reported.
In a second analysis that also controlled for baseline variables, all patients with polyvascular disease were 22% more likely to have a cardiovascular event during their hospitalization compared with the patients with none or one affected arterial bed, a statistically significant difference. Two other factors also had a significant impact in this analysis: Diabetes boosted the risk of an event by 16%, and ST segment depression boosted the risk by 32%.
Patients with polyvascular disease also had a significantly increased risk for requiring a blood transfusion during hospitalization. This link may be a result of confounding, but it may also involve a real cause such as increased access-site problems in patients with peripheral arterial disease, he said.
A prior report from Dr. Bhatt and his associates noted a significantly increased risk of cardiovascular events in those with stable coronary disease with polyvascular disease (JAMA 2007;297:1197–206).
This is a cheap and easy way to prognosticate risk for new cardiovascular events. DR. BHATT