Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT

Inglis, SC; Bebchuk, J; Al-Suhaim, SA; Case, J; Pfeffer, MA; Solomon, SD; Hou, YR; Pitt, B; Dargie, HJ; Ford, I; Kjekshus, J; Zannad, F; Dickstein, K; McMurray, JJV

Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT

Bebchuk, J Al-Suhaim, SA Case, J Pfeffer, MA Solomon, SD Hou, YR Pitt, B Dargie, HJ Ford, I Kjekshus, J Zannad, F Dickstein, K McMurray, JJV

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Publication Type:: Journal Article
Citation:: International Journal of Cardiology, 2013, 168 (2), pp. 1094 - 1101
Issue Date:: 2013-09-30

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Field	Value	Language
dc.contributor.author	Inglis, SC https://orcid.org/0000-0002-1331-5912	en_US
dc.contributor.author	Bebchuk, J	en_US
dc.contributor.author	Al-Suhaim, SA	en_US
dc.contributor.author	Case, J	en_US
dc.contributor.author	Pfeffer, MA	en_US
dc.contributor.author	Solomon, SD	en_US
dc.contributor.author	Hou, YR	en_US
dc.contributor.author	Pitt, B	en_US
dc.contributor.author	Dargie, HJ	en_US
dc.contributor.author	Ford, I	en_US
dc.contributor.author	Kjekshus, J	en_US
dc.contributor.author	Zannad, F	en_US
dc.contributor.author	Dickstein, K	en_US
dc.contributor.author	McMurray, JJV	en_US
dc.date.available	2012-11-02	en_US
dc.date.issued	2013-09-30	en_US
dc.identifier.citation	International Journal of Cardiology, 2013, 168 (2), pp. 1094 - 1101	en_US
dc.identifier.issn	0167-5273	en_US
dc.identifier.uri	http://hdl.handle.net/10453/26363
dc.description.abstract	Objectives: To examine the prevalence of peripheral artery disease (PAD) and the relationship between PAD and cardiovascular (CV) outcomes in subjects with left ventricular systolic dysfunction, heart failure or both after acute myocardial infarction (MI). Background: PAD is associated with poorer prognosis in patients with stable and unstable coronary heart disease but whether PAD is associated with worse outcomes following substantial acute MI is unknown. Methods: Univariate and multivariate Cox proportional hazards modelling was used to compare clinical outcomes in an individual-patient meta-analysis of 4 trials (CAPRICORN, EPHESUS, OPTIMAAL and VALIANT). Results: Of the 28,771 patients randomized, 2357 (8.2%) had PAD. These patients were older and had more co-morbidity and were less likely to be prescribed aspirin or a beta-blocker compared to patients without PAD. Over a mean follow-up of 2.7 years, 5121 (17.8%) patients died and 15,055 (52.3%) experienced CV death or hospitalization. PAD was an independent predictor of all individual and composite CV outcomes examined (including heart failure), with the exception of stroke. In patients with PAD (compared to those without PAD), the adjusted hazard ratio (HR) for all-cause mortality was 1.25 (95% CI 1.15-1.37; p<0.001) and the HR for CV death, non-fatal MI, non-fatal stroke or heart failure hospitalization was 1.24 (1.16-1.33; p<0.001). Conclusions: PAD is common and is an independent predictor of worse outcomes in patients already at high risk after MI because of left ventricular systolic dysfunction, heart failure or both. These patients represent an important group for intensive application of secondary preventive therapies. © 2012 Elsevier Ireland Ltd. All rights reserved.	en_US
dc.relation	http://purl.org/au-research/grants/nhmrc/GNT0472699
dc.relation.ispartof	International Journal of Cardiology	en_US
dc.relation.isbasedon	10.1016/j.ijcard.2012.11.033	en_US
dc.subject.classification	Cardiovascular System & Hematology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Myocardial Infarction	en_US
dc.subject.mesh	Treatment Outcome	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Randomized Controlled Trials as Topic	en_US
dc.subject.mesh	Peripheral Arterial Disease	en_US
dc.title	Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	168	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1102 Cardiorespiratory Medicine and Haematology	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	168	en_US

Abstract:

Objectives: To examine the prevalence of peripheral artery disease (PAD) and the relationship between PAD and cardiovascular (CV) outcomes in subjects with left ventricular systolic dysfunction, heart failure or both after acute myocardial infarction (MI). Background: PAD is associated with poorer prognosis in patients with stable and unstable coronary heart disease but whether PAD is associated with worse outcomes following substantial acute MI is unknown. Methods: Univariate and multivariate Cox proportional hazards modelling was used to compare clinical outcomes in an individual-patient meta-analysis of 4 trials (CAPRICORN, EPHESUS, OPTIMAAL and VALIANT). Results: Of the 28,771 patients randomized, 2357 (8.2%) had PAD. These patients were older and had more co-morbidity and were less likely to be prescribed aspirin or a beta-blocker compared to patients without PAD. Over a mean follow-up of 2.7 years, 5121 (17.8%) patients died and 15,055 (52.3%) experienced CV death or hospitalization. PAD was an independent predictor of all individual and composite CV outcomes examined (including heart failure), with the exception of stroke. In patients with PAD (compared to those without PAD), the adjusted hazard ratio (HR) for all-cause mortality was 1.25 (95% CI 1.15-1.37; p<0.001) and the HR for CV death, non-fatal MI, non-fatal stroke or heart failure hospitalization was 1.24 (1.16-1.33; p<0.001). Conclusions: PAD is common and is an independent predictor of worse outcomes in patients already at high risk after MI because of left ventricular systolic dysfunction, heart failure or both. These patients represent an important group for intensive application of secondary preventive therapies. © 2012 Elsevier Ireland Ltd. All rights reserved.

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http://hdl.handle.net/10453/26363