ABC | Volume 113, Nº3, September 2019

Original Article Clinical Characteristics and Adverse Events in Acute Coronary Syndrome Patients with a History of Peripheral Arterial Disease Yun-Peng Kang, Li-Ying Chen, Tie-Duo Kang, Wen-Xian Li u Beijing An Zhen Hospital affiliated to Capital Medical University, Beijing – China Mailing Address: Wen-Xian Liu • Beijing An Zhen Hospital affiliated to Capital Medical University - No. 2, Anzhen road, Chaoyang district Beijing 100029 – China E-mail: lwx_lwxas88@163.com Manuscript receivedSeptember 19, 2018, revised manuscript December 10, 2018, accepted January 16, 2019 DOI: 10.5935/abc.20190150 Abstract Background: In clinical observation, patients with acute coronary syndrome complicated with peripheral artery disease have poor prognosis, so the relationship between the diseases and clinical characteristics need to be further explored. Objective: This study aims to investigate clinical characteristics and independent risk factors for in-hospital adverse events in acute coronary syndrome patients with a history of peripheral arterial disease (PAD). Methods: A total of 5,682 patients with acute coronary syndrome were included into this study. These patients were divided into two groups according to the presence or absence of a history of PAD: PAD group (n = 188), and non-PAD (control) group (n = 5,494). Then, the clinical characteristics and incidence of in-hospital adverse events were analyzed; p < 0.05 was considered statistically significant. Results: The age of PAD patients was higher than that in the control group (65.5 ± 10.3 years vs. 58.6 ± 11 years, p < 0.001), and the proportion of PAD patients with diabetes history and stroke history was higher than that in the control group (73 [39%] vs. 1472 [26.8%], p = 0.018; 36 [19.3%] vs. 396 [7.2%], p < 0.001). The multivariate logistic regression analysis between groups based on in-hospital adverse events revealed that a history of PAD (OR = 1.791, p = 0.01), a history of diabetes (OR = 1.223, p = 0.001), and age of > 65 years old (OR = 4.670, p < 0.001) were independent risk factors for in-hospital adverse events. Conclusion: A history of PAD, advanced age, and a history of diabetes are independent risk factors for in-hospital adverse events in patients with acute coronary syndrome. (Arq Bras Cardiol. 2019; 113(3):367-372) Keywords: Acute Coronary Syndrome; Atherosclerosis; Mortality; Peripheral Arterial Disease; Hospitalization/ complications; Diabetes Mellitus; Risk Factors. Introduction Atherosclerosis is a systemic vascular disease and one of the main causes of death and disability among Chinese residents. It mainly occurs in the coronary and cerebral arteries and affects the peripheral arteries (upper extremity, lower extremity, mesenteric and carotid arteries). Peripheral artery disease (PAD) is a general name that refers to vascular diseases, except for cardio-cerebrovascular diseases. The narrow concept of PAD mainly refers to atherosclerotic stenosis or occlusion of the lower extremities, which causes symptoms of chronic or acute ischemia in the lower extremities. 1 PAD patients have a high risk of cardiovascular disease. A study 2 revealed that the risk of myocardial infarction in patients with PAD increased by 20‑60%, and the risk of death caused by coronary artery disease (CAD) increased by 2-6 times. Therefore, similar to CAD), PAD can be a powerful predictor of death induced by myocardial infarction, stroke and other vascular diseases, 3 and is closely correlated with the occurrence of death for cardiovascular events. 4 Since the proportion of patients with lower extremity arterial disease is high in patients with PAD, in the present study, the lower extremity arterial disease was included into the concept of PAD and was investigated and discussed. Methods Subjects: A total of 5,682 patients with acute coronary syndrome (ACS), who were admitted to the Department of Cardiology, Beijing Anzhen Hospital from April 2002 to August 2016, were included into the present study. Among these patients, 188 patients had a history of PAD. The age of the patients ranged from 36 to 84 years, with a median age of 64 years old; 143 patients were male (76.1%) and 45 patients were female (23.9%). The remaining 5,494 ACS patients without PAD were assigned as the control group. The age of these patients ranged from 25 to 90 years old, with a median age of 59 years old; 3,972 patients were male (72.3%) and 1,522 patients were female (27.7%). Inclusion and exclusion criteria: Patients diagnosed and treated for ACS, with history of PAD were included into the study. The diagnostic criteria for ACS were based on the 2015 European Society of Cardiology diagnostic criteria. 5 367