Outcomes of acute coronary syndrome patients with concurrent extra-cardiac vascular disease in the era of transradial coronary intervention: A retrospective multicenter cohort study


Autoři: Masaki Kodaira aff001;  Mitsuaki Sawano aff002;  Toshiki Kuno aff001;  Yohei Numasawa aff001;  Shigetaka Noma aff004;  Masahiro Suzuki aff005;  Shohei Imaeda aff002;  Ikuko Ueda aff002;  Keiichi Fukuda aff002;  Shun Kohsaka aff002
Působiště autorů: Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan aff001;  Department of Cardiology, Keio University School of Medicine, Tokyo, Japan aff002;  Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, United States of America aff003;  Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan aff004;  Department of Cardiology, National Hospital Organization Saitama Hospital, Saitama, Japan aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223215

Souhrn

Background

Extra-cardiac vascular diseases (ECVDs), such as cerebrovascular disease (CVD) or peripheral arterial disease (PAD), are frequently observed among patients with acute coronary syndrome (ACS). However, it is not clear how these conditions affect patient outcomes in the era of transradial coronary intervention (TRI).

Methods and results

Among 7,980 patients with ACS whose data were extracted from the multicenter Japanese percutaneous coronary intervention (PCI) registry between August 2008 and March 2017, 888 (11.1%) had one concurrent ECVD (either PAD [345 patients: 4.3%] or CVD [543 patients; 6.8%]), while 87 patients (1.1%) had both PAD and CVD. Overall, the presence of ECVD was associated with a higher risk of mortality (odds ratio [OR]: 1.728; 95% confidence interval [CI]: 1.183–2.524) and bleeding complications (OR: 1.430; 95% CI: 1.028–2.004). There was evidence of interaction between ECVD severity and procedural access site on bleeding complication on the additive scale (relative excess risk due to interaction: 0.669, 95% CI: -0.563–1.900) and on the multiplicative scale (OR: 2.105; 95% CI: 1.075–4.122). While the incidence of death among patients with ECVD remained constant during the study period, bleeding complications among patients with ECVD rapidly decreased from 2015 to 2017, in association with the increasing number of TRI.

Conclusions

Overall, the presence of ECVD was a risk factor for adverse outcomes after PCI for ACS, both mortality and bleeding complications. In the most recent years, the incidence of bleeding complications among patients with ECVD decreased significantly coinciding with the rapid increase of TRI.

Klíčová slova:

Cardiovascular diseases – Coronary angioplasty – Coronary heart disease – Death rates – Hemorrhage – Lesions – Myocardial infarction – Vascular diseases


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2019 Číslo 10