Presenting symptoms, pre-hospital delay time and 28-day case fatality in patients with peripheral arterial disease and acute myocardial infarction from the MONICA/KORA Myocardial Infarction Registry

Abstract

Background: Previous studies have indicated that patients with acute myocardial infarction (AMI) who have a history of peripheral arterial disease (PAD) have different characteristics and poorer outcomes than patients without PAD. However, data on short-term mortality are conflicting and it is unclear whether patients with PAD have a different scope of AMI symptoms or differences in pre-hospital delay time (PHDT) compared with patients without PAD. The objective of this study was to determine the associations between a history of PAD and presenting AMI symptoms, PHDT and 28-day case fatality in a population-based sample of patients with AMI. Design: This was an observational study. Methods: Information on history of PAD was obtained from the patients' medical records and their AMI symptoms were assessed by interviews with patients. Multivariable logistic regression models were used to determine the association of PAD with AMI symptoms and 28-day case fatality. A multivariable linear regression model was developed to examine the relations between PAD and PHDT. Results: From the 5848 patients with AMI included in this study, 9.8% had a history of PAD. Patients with PAD were significantly less likely to report chest symptoms (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.41-0.66) or pain in the upper left extremity (OR 0.67, 95% CI 0.54-0.84) than patients without PAD. PAD was significantly related with longer PHDT in patients <69 years of age (p ¼ 0.0117) and men (p ¼ 0.0104). A significantly higher 28-day case fatality (OR 2.09, 95% CI 1.47-2.96) was found in patients with PAD compared with patients without PAD. Conclusions: Patients with PAD should receive comprehensive education on the possibility of atypical AMI symptoms and the need to call emergency medical services immediately.

Peripheral arterial disease is associated with higher mortality in patients with incident acute myocardial infarction

“…To our knowledge, our study was the first which had a follow-up time up to 12 years and provided survival analyses adjusted for AMI treatment as well as discharge medication. In accordance with other studies [7][8][9][10][11], 8.9% of all AMI survivors had a history of PAD and patients with PAD were older and more likely to have hypertension, diabetes and stroke than patients without PAD [7,13,14,22].…”

“…However, previous studies also provided mixed results, which may be explained by different study characteristics [8,11,[13][14][15][16][17][18]. Some of the studies that found an association between PAD and short-term mortality [8,13,16] have also included patients with unstable angina or polyvascular disease [14,15], were restricted to patients with AMI after PCI [17] or did not provide analyses adjusted for comorbidities and treatment [18].…”

“…PAD is classified as a coronary heart disease equivalent in various treatment guidelines and is linked to acute myocardial infarction (AMI) [3][4][5]. Reported prevalences of PAD among patients with acute coronary syndrome (ACS) range between 8 and 13 % [6][7][8][9][10][11].…”

“…Results from several studies indicate that PAD is independently associated with increased mortality in patients with AMI [6,7,[11][12][13][14][15][16][17] . However, the findings regarding the effect of PAD on shortterm survival are conflicting: some studies have found an adverse effect of PAD [11,[13][14][15][16][17][18] whereas other studies found no significant association between PAD and short-term mortality [6,12]. In terms of long-term mortality, only a few studies are available so far, all indicating an adverse association between PAD and long-term survival [6,7,12].…”

Follow-up of patients after revascularisation for peripheral arterial diseases: a consensus document from the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery

“…The compliance to secondary prevention and exercise training, as well as awareness of revascularisation failure symptoms needing immediate contact with vascular specialists, are important factors of long-term success. [11][12][13][14] Imaging techniques. Because it is non-invasive and widely available, duplex ultrasound (DUS) performed by experienced operators is usually the first-line technique.…”