The Burden of Major Adverse Cardiac Events and Antiplatelet Prevention in Patients with Coronary or Peripheral Arterial Disease

Abstract

SUMMARYBackground: Patients with a history of a cardiovascular (CV) disease are at high risk of suffering secondary major adverse cardiac events (MACE), namely death, nonfatal myocardial infarction (MI), stroke, symptomatic pulmonary embolism, CV and all-cause hospitalization, and bleeding. Methods: A comprehensive review of the literature was conducted to review the epidemiology and burden of MACE in patients with coronary or peripheral arterial disease (CAD or PAD) in Europe and other ex-US regions. Relevant articles published between 2003 and 2013 were retrieved from PubMed and other sites. Results: MACE incidence and prevalence in patients with CAD or PAD were increased by at least 1.4-fold compared with matched controls with no CV disease. In patients with CAD, MACE mostly occurred within 30 days of primary percutaneous coronary intervention; incidence decreased with time. Increased oxidative stress in coronary and peripheral arteries, diabetes, and chronic kidney disease were identified as the main risk factors for MACE in patients with CAD and PAD. Registry data showed that, although preventive antiplatelet therapy was prescribed at high rates, a large proportion (9-56%) of patients did not receive treatment. Furthermore, adherence to treatment declined over time, potentially leading to disease worsening. Conclusion: Despite gaps in the literature, this assessment showed that MACE's risk is substantial among patients with CAD or PAD and that the use of preventive therapies is suboptimal. Development of additional preventive therapies for these patients is warranted.

Implementing a pharmacogenetic-driven algorithm to guide dual antiplatelet therapy (DAPT) in Caribbean Hispanics: protocol for a non-randomised clinical trial

“…Based on preliminary data and prior literature reports, we will assume a primary outcome rate (MACEs) of not less than 3% in the study cohort. [22][23][24] Likewise, we anticipate a prevalence of HTPR and CYP2C19 LOF alleles combined of approximately 30%. 10 11 Sample size and power calculation A sample size of 500 subjects (250 per subcohort) will be included in our study.…”

Frailty Is Associated with an Increased Risk of Major Adverse Cardiac Events in Patients with Stable Claudication

“…With an aging global population, the prevalence of PAD has increased by more than 20% over the last decade with an estimated global disease burden of over 200 million people 3, 4 . The presence of PAD is associated with an increased risk of major adverse cardiac events (MACE), defined as myocardial infarction, coronary revascularization, stroke, or cardiovascular disease associated death 5, 6 . Frailty, a syndrome characterized by decreased physiologic reserves and resistance to stressors, is associated with disability, poor surgical outcomes, and mortality.…”

Anti-platelet and anti-coagulant therapy in peripheral arterial disease prior to surgical intervention

“…13,14 Furthermore, while the risk of adverse cardiovascular events is often seen as comparable between those with CAD and those with PAD, evidence suggests CAD versus non-CAD patients are at a 1.5-2Â fold increased risk of MACE, compared to PAD versus non-PAD patients, where the risk is as high as 4-10Â fold. 15 This may be due to a smaller proportion of PAD patients being actively managed compared to CAD, and adherence to therapy being poor in those with PAD. 2 This paper reviews the current available evidence of anti-platelet and anti-coagulant therapies in patients with PAD with the aim of shedding light on the optimum management of this demanding clinical burden.…”