ABC | Volume 113, Nº3, September 2019

Original Article Kang et al. Acute coronary syndrome patients Arq Bras Cardiol. 2019; 113(3):367-372 Table 1 – Baseline data of acute coronary syndrome patients with and without a history of peripheral arterial disease admitted to hospital Items ACS with a history of PAD (n = 188) ACS without a history of PAD (n = 5,494) p Age (years) 65.5 ± 10.3 58.6 ± 11.0 < 0.001 Male (%) 143(76.1) 3972(72.3) 0.472 History of hypertension (%) 123(65.9) 3175(57.8) 0.129 History of diabetes mellitus (%) 73(39) 1472(26.8) 0.018 Dyslipidemia (%) 24(12.5) 890(16.2) 0.464 History of smoking (%) 104(55.7) 3044(55.4) 0.987 History of alcohol intake (%) 30(15.9) 1170(21.3) 0.464 History of stroke (%) 36(19.3) 396(7.2) < 0.001 SBP (mmHg) 126.36 ± 20.25 124.47 ± 26.67 0.389 DBP (mmHg) 72.47 ± 12.01 74.02 ± 13.03 0.233 HR (bpm) 76.09 ± 14.03 74.44 ± 19.37 0.280 WBC (10 9 /L) 7.3(5.9,9.7) 7.3(5.9,9.6) 0.801 RBC (10 12 /L) 4.3(3.9,4.6) 4.5(4.1,4.8) 0.001 PLT (10 9 /L) 205.04 ± 69.76 206.88 ± 66.03 0.795 ALT(U/L) 26.0(17.0,41.0) 26.0(17.0,44.0) 0.510 Creatinine (mg/dL) 0.97(0.75,1.24) 0.87(0.75,1.02) 0.021 AU (mg/dL) 5.91 ± 1.89 5.78 ± 2.13 0.545 Fasting plasma glucose (mg/dL) 106.3(93.7,147.7) 108.1(93.7,136.9) 0.381 TG (mmol/L) 123.9(79.7,159.4) 132.8(88.5,185.9) 0.079 TC (mg/dL) 166.3(139.2,189.5) 154.6(127.6,170.1) 0.002 LDL-C (mg/dL) 100.62(81.3,123.8) 89.0(73.5,108.4) 0.004 HDL-C (mg/dL) 34.8(27.1,46.4) 34.8(30.9,46.4) 0.586 D-dimer (umol/L) 99.0(50.0,196.2) 105.0(50.0,188.0) 0.832 Data expressed as mean ± standard deviation or median (interquartile range). ACS: acute coronary syndrome; PAD: peripheral arterial disease; SBC: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; WBC: white blood count; RBC: red blood count; PLT: platelet count; ALT: alanine aminotransferase; AU: albumin in urine; TG: triglycerides; TC: total cholesterol; LDL-C: low density lipoprotein; HDL-C: high density lipoprotein. of in-hospital adverse events between the groups revealed that an age of ≥65 years old is an independent risk factor for in‑hospital adverse events (OR = 4.670, p < 0.001). The older the age, the higher the incidence of the adverse events, which is consistent with existing literature. Therefore, for elderly ACS patients with a history of PAD, more attention should be given to changes in patient condition. In the present study, although the incidence of stroke in ACS patients with a history of PAD was higher (19.3%) than in controls, further analysis revealed that it did not affect in-hospital adverse events. Dyslipidemia has been considered an important risk factor for atherosclerosis. 13 Existing studies have shown that cholesterol is closely related to the occurrence and development of PAD. In the formation and development of atherosclerosis, LDL-C plays an important role. Furthermore, evidence supporting the relationship between LDL-C and PAD has been found. 14 The present study also revealed that the level of LDL-C was higher in the PAD group than in the control group. Therefore, lipid-lowering therapy should be strengthened for patients with PAD complicated with ACS. Among the common risk factors for atherosclerosis, diabetes has been well-recognized as an independent risk factor for atherosclerosis. The ARIC study 15 revealed that, as compared with patients with a 0-5-year course of diabetes, the risk for PAD in patients with a course of diabetes of ≥ 6 years significantly increased, and the relative risk was 1.24. The present study also revealed that a history of diabetes was an independent risk factor for in-hospital adverse events (OR = 1.223, p < 0.001). Long-term hyperglycemia affects the elasticity and stiffness of the blood vessel walls, which leads to endothelial dysfunction and microcirculatory dysfunction. Therefore, controlling blood sugar is a necessary measure to reduce the incidence of ACS and PAD. 16 Analysis of the characteristics of coronary arterial lesions revealed that compared with left main coronary artery disease, bifurcation lesions and calcification, and other serious CADs, ACS patients with PAD are more frequently affected by multivessel disease in coronary arteries. Also, atherosclerosis was characterized by extensive vascular involvement in coronary arteries. Therefore, multivessel lesions tend to indicate extensive wall motion abnormalities, leading to poor prognosis. This study has also confirmed this. 369