Prior polyvascular disease: Risk factor for adverse ischaemic outcomes in acute coronary syndromes

Deepak L. Bhatt, Eric D. Peterson, Robert A. Harrington, Fang Shu Ou, Christopher P. Cannon, C. Michael Gibson, Neal S. Kleiman, Ralph G. Brindis, W. Frank Peacock, Sorin J. Brener, Venu Menon, Sidney C. Smith, Charles V. Pollack, W. Brian Gibler, E. Magnus Ohman, Matthew T. Roe

Research output: Contribution to journalArticlepeer-review

160 Scopus citations


Aims: The presence of peripheral arterial disease (PAD) or cerebrovascular disease (CVD) is associated with higher likelihood of significant coronary artery disease (CAD). We sought to assess the prevalence of PAD, CVD, prior CAD, or pre-existent disease in multiple arterial territories ('polyvascular' disease) in patients presenting with non-ST-segment elevation acute coronary syndrome and its impact on adverse events.Methods and resultsData from 95 749 patients enrolled from February 2003 to September 2006 at 484 sites in the CRUSADE registry were analysed. Patients were categorized as having prior 0, 1, 2, or 3 affected arterial beds. The rates of in-hospital mortality, myocardial infarction, stroke, and congestive heart failure were analysed, as were the rates of non-bypass surgery-related red blood cell transfusion and major bleeding. On presentation, 11 345 (11.9) patients had established PAD, 9973 (10.4) had documented CVD, and 41 404 (43.2) had prior CAD. In this cohort, 0, 1, 2, and 3 arterial bed disease before presentation was present in 46 814 (48.9, 95 CI 48.6-49.2), 36 704 (38.3, 95 CI 37.8-39.0), 10 675 (11.2, 95 CI 10.9-11.9), and 1556 (1.6, 95 CI 1.5-1.8) patients, respectively. The rates of ischaemic events increased with the number of affected vascular beds. The adjusted odds ratio for the composite of in-hospital ischaemic events for pre-existent disease in 1, 2, or 3 arterial beds (compared with 0 arterial bed involvement) increased from 1.07 to 1.26 to 1.31 (P < 0.001). Similarly, the adjusted odds ratio for transfusion increased with greater disease burden from 1.11 to 1.28 to 1.30 (P < 0.001), although the adjusted rates of protocol-defined non-bypass surgery-related major bleeding did not.ConclusionPrior polyvascular disease increases the risk of in-hospital adverse events, including mortality. Identification of these patients in clinical trial and real world populations may provide an opportunity to reduce their excess risk with intensive secondary prevention efforts.

Original languageEnglish (US)
Pages (from-to)1195-1202
Number of pages8
JournalEuropean heart journal
Issue number10
StatePublished - May 2009


  • Acute coronary syndromes
  • Cerebrovascular disease
  • Coronary artery disease
  • Peripheral arterial disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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