The prognostic value of peripheral arteries diseases in patients with ST-segment elevation myocardial infarction
Abstract
Aims. To evaluate the clinical and prognostic role of hemodynamically insignificant stenosis of the extracranial arteries and lower extremity arteries in patients after myocardial infarction with ST – Seg ment elevation.
Methods and results. The study sample consisted of 423 consecutively admitted patients in Kemerovo Cardiological Clinic with ST-Segment elevation myocardial infarction (STEMI). The disease outcome was defined in 397 patients (95.4 % of the initially discharged patients) a year later. 39 fatal outcomes were registered.
Results. The incidence of polyvascular diseases (PVD), defined by the intima-media thickness of the common carotid artery or presenting stenosis of any severity of the extracranial arteries (ECA) or lower extremity arteries (LEA) was substantially high – 95 %. The increasing severity degree of peripheral arteries stenosis was noted to raise significantly the cardiovascular risk factors incidence. In patients without PVD (n = 18) no fatal outcomes were registered, in patients with the ECA or LEA stenosis – >30 % (n = 193), the mortality rate was 5.7 %, and with stenosis < 30 % (n = 186) – 15,1 % (χ2 = 11,4, p = 0.003). Using the GRACE score model together with the additional factors determination (presenting congestive heart failure, PVD, prior stroke, smoking) enables to create a scheme (KemScore) of death risk stratification for 12-month period, with the value of the area under the ROC-curve 0.83 (0.76, 0.90), that is significantly higher than the initial GRACE score – 0.71 (0.63, 0.79).
Conclusion. Additional risk factors determination, including peripheral arterial stenosis of 30 % and more, enables to optimize the predictive GRACE score model value.
About the Authors
M. V. Zykov
Ministry of Health and Social Development of Russia
Russian Federation
Russian Federation
State Budgetary Educational Institution of Higher Professional Education Kemerovo State Medical Academy
650029
Voroshilov Street, 22a
Kemerovo
D. S. Zykova
RAMS
Russian Federation
Russian Federation
SB RAMS
Federal State Budgetary Institution Research Institute of Complex Problems of Cardiovascular Diseases
650002
Pine Boulevard, 6
Kemerovo
V. V. Kashtalap
RAMS
Russian Federation
Russian Federation
SB RAMS
Federal State Budgetary Institution Research Institute of Complex Problems of Cardiovascular Diseases
650002
Pine Boulevard, 6
Kemerovo
T. B. Pecherina
Ministry of Health and Social Development of Russia
Russian Federation
Russian Federation
State Budgetary Educational Institution of Higher Professional Education Kemerovo State Medical Academy
650029
Voroshilov Street, 22a
Kemerovo
O. L. Barbarash
RAMS
Russian Federation
Russian Federation
SB RAMS
Federal State Budgetary Institution Research Institute of Complex Problems of Cardiovascular Diseases
650002
Pine Boulevard, 6
Kemerovo
References
1. Morrow D. A., Antman E. M., Charlesworth A. et al. TIMI risk score for ST-elevation myocardial infarction. A convenient, bedside, clinical score for risk assessment at presentation. An intravenous nPA for Treatment of infracting Myocardium Early II Trial substudy // Circulation. 2000. Vol. 102. С. 2031–2037.
2. Fox K., Dabbous O. H., Goldberg R. J., Pieper K. S., Kim A., Eagle K. A., Van de Werf F., Avezum A., Shaun G., Goodman S. G., Flather M. D., Anderson F. A., Jr, Granger C. B. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE) // British Med. J. 2006. Vol. 333. P. 1091.
3. Lev E. I., Kornowski R., Vaknin-Assa H. et al. Comparison of the predictive value of four different risk scores for outcomes of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention // Am. J. Cardiol. 2008. Vol. 102. P. 6–11.
4. Ferreira-González I., Miralda G. P., Heras M. et al. Prognosis and Management of Patients With Acute Coronary Syndrome and Polyvascular Disease // Rev. Esp. Cardiol. 2009. Vol. 62, N 9. P. 1012–1021.
5. Werf F. V., Bax J., Betriu A. et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation // Eur. Heart J. 2008. Vol. 29. P. 2909–2945.
6. Spenser F. A., Lessard D., Doubeni C. et al. Treatment practices and outcomes of patients with established peripheral arterial disease hospitalized with acute myocardial infarction in a community setting // Am. Heart J. 2007. Vol. 153. Р. 140–146.
7. Kablak-Ziembicka A., Tracz W., Przewlocki T. et al. Association of increased carotid intima-media thickness with the extent of coronary artery disease // Heart. 2004. Vol. 90. P. 1286–1290.
8. Coccheri S. Distribution of symptomatic atherothrombosis and influence of atherosclerotic disease burden on risk of secondary ischaemic events: results from CAPRIE // Eur. Heart J. 1998. Vol. 19 (Suppl. l). Р. 1268.
9. Bhatt D. L. On behalf of the REACH Registry Investigators. International prevalence, Recognition, and treatment of cardiovascular risk factor in outpatient with atherothrombosis // JAMA. 2006. Vol. 295 N 2. P. 180–189.
10. Aqel R. A., Zoghbi G. J., Baldwin S. A. Prevalence of renal artery stenosis in high-risk veterans referred to cardiac catheterization // J. Hypertens. 2003. Vol. 21. Р. 1157–1162.
11. Poredos P., Jug B. The prevalence of peripheral arterial in high risk subjects and coronary or cerebrovascular patients // Angiology. 2007. Vol. 58, N 3. P. 309–315.
12. Calvet D., Touzé E., Varenne O. et al. Prevalence of Asymptomatic Coronary Artery Disease in Ischemic Stroke Patients: The PRECORIS Study // Circulation. 2010. Vol. 121. P. 1623–1629.
13. Kuijk J. P., Flu W. J., Welten G. M. et al. Long-term prognosis of patients with peripheral arterial disease with or without polyvascular atherosclerotic disease // Eur. Heart J. 2009. Vol. 32, N 11. P. 992–999.
14. Belcaro G., Nicolaides A. N., Ramaswami G. et al. Carotid and femoral ultrasound morphology screening and cardiovascular events in low risk subjects: a 10-vear follow -up study (the CAFES-CAVE study) // Atherosclerosis. 2001. Vol. 156. P. 379–387.
15. de Araújo Gonçalves P., Ferreira J., Aguiar C., Seabra-Gomes R. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS // Eur. Heart J. 2005. Vol. 26, N 9. P. 865–872.
16. Abu-Assi E., García-Acuña J. M., Peña-Gil C. Validation of the GRACE Risk Score for Predicting Death Within 6 Months of Follow-Up in a Contemporary Cohort of Patients With Acute Coronary Syndrome // Rev. Esp. Cardiol. 2010. Vol. 63, N 6. P. 640–648.
Review
For citations:
Zykov M.V., Zykova D.S., Kashtalap V.V., Pecherina T.B., Barbarash O.L. The prognostic value of peripheral arteries diseases in patients with ST-segment elevation myocardial infarction. Ateroscleroz. 2012;8(1):14-20. (In Russ.)
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