ABC | Volume 113, Nº3, September 2019

Original Article Kang et al. Acute coronary syndrome patients Arq Bras Cardiol. 2019; 113(3):367-372 Table 2 – Characteristics of coronary artery lesions in acute coronary syndrome patients with and without a history of peripheral arterial disease [case(%)] Items ACS with a history of PAD (n = 188) ACS without a history of PAD (n = 5494) p Left main coronary artery disease 9(4.8) 206(3.7) 0.777 Multivessel stenosis 22(12.1) 478(8.7) 0.015 Bifurcation lesion 27(14.4) 917(16.7) 0.782 Occlusion lesion 18(4.3) 191(3.6) 0.511 History of diabetes Calcified lesions 3(0.7) 15(0.2) 0.656 ACS: acute coronary syndrome; PAD: peripheral arterial disease. Table 3 – The incidence of adverse events in acute coronary syndrome patients with and without a history of peripheral arterial disease [case(%)] Items ACS merged with PAD history (n = 188) ACS not merged with PAD history (n = 5,494) p Death 5(2.6) 23(0.4) 0.035 Cardiogenic shock 6(3.1) 203(3.7) 0.435 Acute left heart failure 7(3.7) 174(3.2) 0.355 Cardiac rupture 0(0) 2(0.03) 0.707 ACS: acute coronary syndrome. PAD: peripheral arterial disease. Table 4 – Multivariate Logistic regression analysis based on in-hospital adverse events Items SE OR 95%CI p History of PAD 0.220 1.791 1.05-2.88 0.010 History of hypertension 0.169 1.112 0.79-1.55 0.529 History of diabetes mellitus 0.082 1.223 1.01-1.41 < 0.001 Age > 65 years old 0.181 4.670 3.21-6.44 < 0.001 Multivessel disease 1.015 0.625 0.08-4.57 0.643 PAD: peripheral arterial disease. In the present study, analysis of in-hospital adverse events revealed that in-hospital mortality in ACS patients with PAD was 1.1% (p = 0.035), and the difference was statistically significant when compared with the control group. A meta‑analysis revealed that after 2.7 years of follow-up for patients with acute myocardial infarction complicated with a PAD history, cardiovascular deaths occurred in 17.8% of patients, and 52.3% of these patients, and only 28% of patients without PAD experienced re-hospitalization caused by nonfatal myocardial infarction, nonfatal stroke and heart failure. Therefore, PAD is an independent risk factor for predicting poor outcomes. 17 Thus, it can be concluded that patients with a history of PAD are more likely to experience many adverse events. In the present study, mortality due to adverse events was lower than that reported in the literature. The reasons for these differences may be that the subjects included in the present study were ACS patients, including low-risk patients such as patients with unstable angina. Furthermore, patients were not followed-up, and only in-hospital cardiovascular deaths were counted. The limitation of the present study was that it had a single‑center, retrospective design, and a single-center study may have bias in case selection. Furthermore, our sample (ACS population) included patients with unstable angina, non‑ST‑segment elevation myocardial infarction and ST‑segment elevation myocardial infarction. The difference in severity between these conditions may have led to observation bias. Conclusion Patients with ACS complicated with a history of PAD have extensive coronary disease and high in-hospital mortality. A history of PAD is an independent risk factor for in-hospital adverse events. 370