Outcomes After Acute Coronary Syndrome in Patients With Diabetes Mellitus and Peripheral Artery Disease (from the TRACER, TRILOGY-ACS, APPRAISE-2, and PLATO Clinical Trials)
Patients with acute coronary syndrome (ACS) are at risk for recurrent adverse events, and multiple reports suggest that this risk is increased in patients with concomitant diabetes mellitus (DM) and peripheral artery disease (PAD). The aim of this article was to investigate cardiovascular outcomes i...
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| Veröffentlicht in: | The American journal of cardiology 2022-09, Vol.178, p.11-17 |
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| creator | Attar, Rubina Wu, Angie Wojdyla, Daniel Jensen, Svend Eggert Andell, Pontus Mahaffey, Kenneth W. Roe, Matthew T. James, Stefan K. Wallentin, Lars Vemulapalli, Sreekanth Alexander, John H. Lopes, Renato D. Ohman, E. Magnus Hernandez, Adrian F. Patel, Manesh R. Jones, W. Schuyler |
| description | Patients with acute coronary syndrome (ACS) are at risk for recurrent adverse events, and multiple reports suggest that this risk is increased in patients with concomitant diabetes mellitus (DM) and peripheral artery disease (PAD). The aim of this article was to investigate cardiovascular outcomes in patients with DM presenting with ACS, stratified by PAD status. Data were derived from 4 randomized post-ACS trials (PLATO [Platelet Inhibition and Patient Outcomes], APPRAISE-2 p Apixaban for Prevention of Acute Ischemic Events 2], TRILOGY [Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage], and TRACER [Thrombin Receptor Agonist for Clinical Event Reduction in Acute Coronary Syndrome]). Using Cox regression analysis, we investigated major adverse cardiovascular events (MACEs), a composite of cardiovascular mortality, myocardial infarction (MI), or stroke and the individual components of MACE and all-cause mortality in patients with DM, presenting with ACS, stratified by PAD status as the risk modifier. This study included 15,387 patients with a diagnosis of DM and ACS, of whom 1,751 had an additional diagnosis of PAD. PAD was associated with more than doubled rates of MACE (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.81 to 2.27), all-cause mortality (HR 2.48, 95% CI 2.14 to 2.87), cardiovascular mortality (HR 2.42, 95% CI 2.04 to 2.86), and MI (HR 2.07, 95% CI 1.79 to 2.38). Patients with both PAD and DM were also more optimally treated with antihypertensive, antidiabetic, and statin medication at baseline. In conclusion, this analysis of 4 major post-ACS trials showed that patients with DM and PAD had a substantially higher risk of MACE, cardiovascular mortality, all-cause mortality, and MI despite being optimally treated with guideline-based therapies. |
| doi_str_mv | 10.1016/j.amjcard.2022.04.062 |
| format | Article |
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Magnus ; Hernandez, Adrian F. ; Patel, Manesh R. ; Jones, W. Schuyler</creator><creatorcontrib>Attar, Rubina ; Wu, Angie ; Wojdyla, Daniel ; Jensen, Svend Eggert ; Andell, Pontus ; Mahaffey, Kenneth W. ; Roe, Matthew T. ; James, Stefan K. ; Wallentin, Lars ; Vemulapalli, Sreekanth ; Alexander, John H. ; Lopes, Renato D. ; Ohman, E. Magnus ; Hernandez, Adrian F. ; Patel, Manesh R. ; Jones, W. Schuyler</creatorcontrib><description>Patients with acute coronary syndrome (ACS) are at risk for recurrent adverse events, and multiple reports suggest that this risk is increased in patients with concomitant diabetes mellitus (DM) and peripheral artery disease (PAD). The aim of this article was to investigate cardiovascular outcomes in patients with DM presenting with ACS, stratified by PAD status. Data were derived from 4 randomized post-ACS trials (PLATO [Platelet Inhibition and Patient Outcomes], APPRAISE-2 p Apixaban for Prevention of Acute Ischemic Events 2], TRILOGY [Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage], and TRACER [Thrombin Receptor Agonist for Clinical Event Reduction in Acute Coronary Syndrome]). Using Cox regression analysis, we investigated major adverse cardiovascular events (MACEs), a composite of cardiovascular mortality, myocardial infarction (MI), or stroke and the individual components of MACE and all-cause mortality in patients with DM, presenting with ACS, stratified by PAD status as the risk modifier. This study included 15,387 patients with a diagnosis of DM and ACS, of whom 1,751 had an additional diagnosis of PAD. PAD was associated with more than doubled rates of MACE (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.81 to 2.27), all-cause mortality (HR 2.48, 95% CI 2.14 to 2.87), cardiovascular mortality (HR 2.42, 95% CI 2.04 to 2.86), and MI (HR 2.07, 95% CI 1.79 to 2.38). Patients with both PAD and DM were also more optimally treated with antihypertensive, antidiabetic, and statin medication at baseline. In conclusion, this analysis of 4 major post-ACS trials showed that patients with DM and PAD had a substantially higher risk of MACE, cardiovascular mortality, all-cause mortality, and MI despite being optimally treated with guideline-based therapies.</description><identifier>ISSN: 0002-9149</identifier><identifier>ISSN: 1879-1913</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2022.04.062</identifier><identifier>PMID: 35835600</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Coronary Syndrome - complications ; Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - drug therapy ; Acute coronary syndromes ; Allmänmedicin ; Antidiabetics ; Antihypertensives ; Atherosclerosis ; Cardiac and Cardiovascular Systems ; Cardiac arrhythmia ; Cardiovascular disease ; Cardiovascular diseases ; Cerebral infarction ; Clinical Medicine ; Clinical trials ; Coronary vessels ; Creatinine ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - drug therapy ; Diabetes Mellitus - epidemiology ; Diagnosis ; Enzymes ; Family Medicine ; Glucagon ; Glucose ; Health risks ; Heart attacks ; Heart failure ; Humans ; Hypertension ; Ischemia ; Kardiologi ; Klinisk medicin ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Mortality ; Myocardial Infarction ; Optimization ; Patients ; Peptides ; Peripheral Arterial Disease - complications ; Peripheral Arterial Disease - epidemiology ; Platelets ; Randomized Controlled Trials as Topic ; Regression analysis ; Risk ; Sensitivity analysis ; Statistical analysis ; Stroke ; Thrombin ; Treatment Outcome ; Vascular diseases ; Vein & artery diseases</subject><ispartof>The American journal of cardiology, 2022-09, Vol.178, p.11-17</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><rights>2022. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c537t-d5bdbebbc279d3107744d1ac087932c8b9ab5a4f13a0382c4c48ea7e5475b2793</citedby><cites>FETCH-LOGICAL-c537t-d5bdbebbc279d3107744d1ac087932c8b9ab5a4f13a0382c4c48ea7e5475b2793</cites><orcidid>0000-0003-1009-4189</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914922005793$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35835600$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-491564$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/4bfec58a-7d36-4a61-a186-878e81229043$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:151942869$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Attar, Rubina</creatorcontrib><creatorcontrib>Wu, Angie</creatorcontrib><creatorcontrib>Wojdyla, Daniel</creatorcontrib><creatorcontrib>Jensen, Svend Eggert</creatorcontrib><creatorcontrib>Andell, Pontus</creatorcontrib><creatorcontrib>Mahaffey, Kenneth W.</creatorcontrib><creatorcontrib>Roe, Matthew T.</creatorcontrib><creatorcontrib>James, Stefan K.</creatorcontrib><creatorcontrib>Wallentin, Lars</creatorcontrib><creatorcontrib>Vemulapalli, Sreekanth</creatorcontrib><creatorcontrib>Alexander, John H.</creatorcontrib><creatorcontrib>Lopes, Renato D.</creatorcontrib><creatorcontrib>Ohman, E. Magnus</creatorcontrib><creatorcontrib>Hernandez, Adrian F.</creatorcontrib><creatorcontrib>Patel, Manesh R.</creatorcontrib><creatorcontrib>Jones, W. Schuyler</creatorcontrib><title>Outcomes After Acute Coronary Syndrome in Patients With Diabetes Mellitus and Peripheral Artery Disease (from the TRACER, TRILOGY-ACS, APPRAISE-2, and PLATO Clinical Trials)</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Patients with acute coronary syndrome (ACS) are at risk for recurrent adverse events, and multiple reports suggest that this risk is increased in patients with concomitant diabetes mellitus (DM) and peripheral artery disease (PAD). The aim of this article was to investigate cardiovascular outcomes in patients with DM presenting with ACS, stratified by PAD status. Data were derived from 4 randomized post-ACS trials (PLATO [Platelet Inhibition and Patient Outcomes], APPRAISE-2 p Apixaban for Prevention of Acute Ischemic Events 2], TRILOGY [Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage], and TRACER [Thrombin Receptor Agonist for Clinical Event Reduction in Acute Coronary Syndrome]). Using Cox regression analysis, we investigated major adverse cardiovascular events (MACEs), a composite of cardiovascular mortality, myocardial infarction (MI), or stroke and the individual components of MACE and all-cause mortality in patients with DM, presenting with ACS, stratified by PAD status as the risk modifier. This study included 15,387 patients with a diagnosis of DM and ACS, of whom 1,751 had an additional diagnosis of PAD. PAD was associated with more than doubled rates of MACE (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.81 to 2.27), all-cause mortality (HR 2.48, 95% CI 2.14 to 2.87), cardiovascular mortality (HR 2.42, 95% CI 2.04 to 2.86), and MI (HR 2.07, 95% CI 1.79 to 2.38). Patients with both PAD and DM were also more optimally treated with antihypertensive, antidiabetic, and statin medication at baseline. In conclusion, this analysis of 4 major post-ACS trials showed that patients with DM and PAD had a substantially higher risk of MACE, cardiovascular mortality, all-cause mortality, and MI despite being optimally treated with guideline-based therapies.</description><subject>Acute Coronary Syndrome - complications</subject><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - drug therapy</subject><subject>Acute coronary syndromes</subject><subject>Allmänmedicin</subject><subject>Antidiabetics</subject><subject>Antihypertensives</subject><subject>Atherosclerosis</subject><subject>Cardiac and Cardiovascular Systems</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cerebral infarction</subject><subject>Clinical Medicine</subject><subject>Clinical trials</subject><subject>Coronary vessels</subject><subject>Creatinine</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diagnosis</subject><subject>Enzymes</subject><subject>Family Medicine</subject><subject>Glucagon</subject><subject>Glucose</subject><subject>Health risks</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Ischemia</subject><subject>Kardiologi</subject><subject>Klinisk medicin</subject><subject>Medical and Health Sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Mortality</subject><subject>Myocardial Infarction</subject><subject>Optimization</subject><subject>Patients</subject><subject>Peptides</subject><subject>Peripheral Arterial Disease - complications</subject><subject>Peripheral Arterial Disease - epidemiology</subject><subject>Platelets</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Regression analysis</subject><subject>Risk</subject><subject>Sensitivity analysis</subject><subject>Statistical analysis</subject><subject>Stroke</subject><subject>Thrombin</subject><subject>Treatment Outcome</subject><subject>Vascular diseases</subject><subject>Vein & artery diseases</subject><issn>0002-9149</issn><issn>1879-1913</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFktuq00AUhoMo7rr1EZQBb7bQ1DnmcCWhu2qh0tJWxathMlm1U9OkziRKH8p3dNXWfSFsvBhWDt_6Etb6o-g5oyNGWfJ6NzL7nTW-GnHK-YjKEU34g2jAsjSPWc7Ew2hAKeVxzmR-FT0JYYe3jKnkcXQlVCZUQukg-jXvO9vuIZBi04Enhe07IOPWt43xR7I6NpXH18Q1ZGE6B00XyGfXbcmtMyV02PcB6tp1fSCmqcgCvDtswZuaFB59R-QCmADkZoMe0m2BrJfFeLIcYp3O5u--xMV4NSTFYrEspqtJzIdn0axYz8m4do2zKFt7Z-rw6mn0aIMVnl3qdfTx7WQ9fh-jaDouZrFVIu3iSpVVCWVpeZpXgtE0lbJixlKcjeA2K3NTKiM3TBgqMm6llRmYFJRMVYk94jqKz97wEw59qQ_e7XEcujVOXx59wyvQUnEmFPKze_m6P-Ap8fxpKDdgVWZ0WolES5MwbViW6CzNIGOc51QK1A3v1d26T4Vu_Vfd91rmuE6J-M0ZP_j2ew-h03sXLK7FNND2QfMkZ1SJTDBEX_6D7treNzhLzVPKqEwSfhKqM2V9G4KHzd0fMKpP6dM7fUmfPqVPU6kxfdj34mLvyz1Ud11_44bAmzMAuLwfDrwOFjNloXIebKer1v3nE78BaW_rBQ</recordid><startdate>20220901</startdate><enddate>20220901</enddate><creator>Attar, Rubina</creator><creator>Wu, Angie</creator><creator>Wojdyla, Daniel</creator><creator>Jensen, Svend Eggert</creator><creator>Andell, Pontus</creator><creator>Mahaffey, Kenneth W.</creator><creator>Roe, Matthew T.</creator><creator>James, Stefan K.</creator><creator>Wallentin, Lars</creator><creator>Vemulapalli, Sreekanth</creator><creator>Alexander, John H.</creator><creator>Lopes, Renato D.</creator><creator>Ohman, E. 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Magnus</au><au>Hernandez, Adrian F.</au><au>Patel, Manesh R.</au><au>Jones, W. Schuyler</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes After Acute Coronary Syndrome in Patients With Diabetes Mellitus and Peripheral Artery Disease (from the TRACER, TRILOGY-ACS, APPRAISE-2, and PLATO Clinical Trials)</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2022-09-01</date><risdate>2022</risdate><volume>178</volume><spage>11</spage><epage>17</epage><pages>11-17</pages><issn>0002-9149</issn><issn>1879-1913</issn><eissn>1879-1913</eissn><abstract>Patients with acute coronary syndrome (ACS) are at risk for recurrent adverse events, and multiple reports suggest that this risk is increased in patients with concomitant diabetes mellitus (DM) and peripheral artery disease (PAD). The aim of this article was to investigate cardiovascular outcomes in patients with DM presenting with ACS, stratified by PAD status. Data were derived from 4 randomized post-ACS trials (PLATO [Platelet Inhibition and Patient Outcomes], APPRAISE-2 p Apixaban for Prevention of Acute Ischemic Events 2], TRILOGY [Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage], and TRACER [Thrombin Receptor Agonist for Clinical Event Reduction in Acute Coronary Syndrome]). Using Cox regression analysis, we investigated major adverse cardiovascular events (MACEs), a composite of cardiovascular mortality, myocardial infarction (MI), or stroke and the individual components of MACE and all-cause mortality in patients with DM, presenting with ACS, stratified by PAD status as the risk modifier. This study included 15,387 patients with a diagnosis of DM and ACS, of whom 1,751 had an additional diagnosis of PAD. PAD was associated with more than doubled rates of MACE (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.81 to 2.27), all-cause mortality (HR 2.48, 95% CI 2.14 to 2.87), cardiovascular mortality (HR 2.42, 95% CI 2.04 to 2.86), and MI (HR 2.07, 95% CI 1.79 to 2.38). Patients with both PAD and DM were also more optimally treated with antihypertensive, antidiabetic, and statin medication at baseline. In conclusion, this analysis of 4 major post-ACS trials showed that patients with DM and PAD had a substantially higher risk of MACE, cardiovascular mortality, all-cause mortality, and MI despite being optimally treated with guideline-based therapies.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35835600</pmid><doi>10.1016/j.amjcard.2022.04.062</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1009-4189</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2022-09, Vol.178, p.11-17 |
| issn | 0002-9149 1879-1913 1879-1913 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_452135 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Acute Coronary Syndrome - complications Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - drug therapy Acute coronary syndromes Allmänmedicin Antidiabetics Antihypertensives Atherosclerosis Cardiac and Cardiovascular Systems Cardiac arrhythmia Cardiovascular disease Cardiovascular diseases Cerebral infarction Clinical Medicine Clinical trials Coronary vessels Creatinine Diabetes Diabetes mellitus Diabetes Mellitus - drug therapy Diabetes Mellitus - epidemiology Diagnosis Enzymes Family Medicine Glucagon Glucose Health risks Heart attacks Heart failure Humans Hypertension Ischemia Kardiologi Klinisk medicin Medical and Health Sciences Medicin och hälsovetenskap Mortality Myocardial Infarction Optimization Patients Peptides Peripheral Arterial Disease - complications Peripheral Arterial Disease - epidemiology Platelets Randomized Controlled Trials as Topic Regression analysis Risk Sensitivity analysis Statistical analysis Stroke Thrombin Treatment Outcome Vascular diseases Vein & artery diseases |
| title | Outcomes After Acute Coronary Syndrome in Patients With Diabetes Mellitus and Peripheral Artery Disease (from the TRACER, TRILOGY-ACS, APPRAISE-2, and PLATO Clinical Trials) |
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