Clinical Outcomes and Resource Utilization in Patients With Peripheral Arterial Disease Hospitalized for Acute Coronary Syndrome

Nameer Ascandar; Joseph Hadaya; Nam Yong Cho; Konmal Ali; Yas Sanaiha; Peyman Benharash

doi:10.1016/j.amjcard.2024.04.049

Clinical Outcomes and Resource Utilization in Patients With Peripheral Arterial Disease Hospitalized for Acute Coronary Syndrome

Am J Cardiol. 2024 Jul 1:222:72-77. doi: 10.1016/j.amjcard.2024.04.049. Epub 2024 May 1.

Authors

Nameer Ascandar¹, Joseph Hadaya², Nam Yong Cho², Konmal Ali², Yas Sanaiha², Peyman Benharash³

Affiliations

¹ Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Internal Medicine, HCA Florida Sarasota Doctors Hospital, Sarasota, Florida.
² Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
³ Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: PBenharash@mednet.ucla.edu.

PMID: 38701873
DOI: 10.1016/j.amjcard.2024.04.049

Abstract

Previous studies have shown an association between acute limb ischemia and higher mortality in patients with acute myocardial infarction. Although peripheral artery disease (PAD) is a well-known risk factor for development of macrovascular pathology, the effect of its severity is not well investigated in patients hospitalized for acute coronary syndrome (ACS). Using a national cohort of patients with various degrees of PAD, we investigated in-hospital outcomes in patients who were admitted for ACS. Using the 2016 to 2020 Nationwide Readmissions Database, we queried all patients who were hospitalized for ACS (unstable angina, non-ST-elevation myocardial infarction, and ST-elevation myocardial infarction). Patients were further divided into 3 groups, either no PAD (non-PAD), PAD, or critical limb ischemia (CLI). Multivariable models were designed to adjust for patient and hospital factors and examine the association between ACS and PAD severity. Of approximately 3,834,181 hospitalizations for ACS, 6.4% had PAD, 0.2% had CLI, and all others were non-PAD. After risk adjustment, in-hospital mortality was higher by 24% in PAD (adjusted odds ratio 1.24, 95% confidence interval [CI] 1.21 to 1.28) and 86% in CLI (adjusted odds ratio 1.86, 95% CI 1.62 to 2.09) compared with non-PAD. Furthermore, PAD and CLI were linked to 1.23-fold (95% CI 1.20 to 1.26) and 1.67-fold (95% CI 1.45 to 1.86) greater odds of cardiogenic shock compared with non-PAD. Additionally, PAD and CLI were linked with higher odds of mechanical circulatory support usage, cardiac arrest and acute kidney injury compared with non-PAD. Lastly, duration of hospital stay, hospitalization costs and odds of non-home discharge and 30-day readmissions were greater in patients with PAD and CLI compared with non-PAD. PAD severity was associated with worse clinical outcomes in patients with ACS, including in-hospital mortality and resource utilization.

Keywords: NSTEMI; STEMI; acute coronary syndrome; critical limb ischemia; peripheral arterial disease; unstable angina.

MeSH terms

Acute Coronary Syndrome* / epidemiology
Acute Coronary Syndrome* / mortality
Acute Coronary Syndrome* / therapy
Aged
Aged, 80 and over
Female
Health Resources / statistics & numerical data
Hospital Mortality* / trends
Hospitalization / statistics & numerical data
Humans
Length of Stay / statistics & numerical data
Male
Middle Aged
Patient Readmission / statistics & numerical data
Peripheral Arterial Disease* / complications
Peripheral Arterial Disease* / epidemiology
Retrospective Studies
Risk Factors
Severity of Illness Index
Shock, Cardiogenic / epidemiology
United States / epidemiology