Background: Atherothrombosis should be considered a systemic disease that may involve one or more than one vascular beds. Data on the impact of polyvascular disease on long-term prognosis in patients with acute coronary syndrome (ACS) are still scarce.
Aim: To assess the prevalence of symptomatic polyvascular disease in a cohort of patients with ACS and to investigate the impact on long-term outcomes of single versus multiple vascular beds involvement.
Methods: We analyzed a nationwide, comprehensive, and universal administrative database of consecutive patients older than 40 years admitted for a new episode of ACS in 2013-14 in Italy.
Patients with ACS were stratified according to the presence of Peripheral Arterial Disease (PAD) only, Cerebrovascular Disease (CeVD) only, PAD and CeVD (PAD+CeVD) or neither (noPAD/noCeVD). A Cox proportional hazard multivariate model was used to evaluate the impact of PAD only, CeVD only and PAD+CeVD on 5-year MACCE.
Results: 331320 new episode of ACS were identified. Among them, 24491 (7.4%) were patients with PAD only, 16269 (4.9%) with CeVD only and 4710 (1.4%) with PAD+CeVD. The 5 years MACCE was 42.6%, 64.7%, 66.1 and 72.2 (0.001) for noPAD/noCeVD , PAD only, CeVD only and PAD+CeVD, respectivelly. After adjustment for age, sex, and comorbidities, the hazard ratio (HR) for 5-year MACCE was 1.30 (0.0001), 1.39 (0.0001), and 1.46 (0.0001) in patients with PAD only, CeVD only, and PAD+CeVD, respectively, as compared with patients without PAD and CeVD.
Conclusion: Polyvascular disease represents a major risk factor in patients with ACS. The simultaneous involvement of three vascular beds further increases the risk of long-term outcomes. Greater effort should be directed toward identification of subclinical/clinical atherosclerosis of beds different from coronary for a better risk stratification.