Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT
Identifieur interne : 004D53 ( Main/Exploration ); précédent : 004D52; suivant : 004D54Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT
Auteurs : Sally C. Inglis [Royaume-Uni, Australie] ; Judith Bebchuk [États-Unis] ; Sultan A. Al-Suhaim [Royaume-Uni] ; Jessica Case [États-Unis] ; Marc A. Pfeffer [États-Unis] ; Scott D. Solomon [États-Unis] ; YINGXIN HOU [États-Unis] ; Bertram Pitt [États-Unis] ; Henry J. Dargie [Royaume-Uni] ; Ian Ford [Royaume-Uni] ; John Kjekshus [Norvège] ; Faiez Zannad [France] ; Kenneth Dickstein [Norvège] ; John J. V. Mcmurray [Royaume-Uni]Source :
- International journal of cardiology [ 0167-5273 ] ; 2013.
Descripteurs français
- Pascal (Inist)
- Wicri :
English descriptors
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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.
Affiliations:
- Australie, France, Norvège, Royaume-Uni, États-Unis
- District de Columbia, Grand Est, Lorraine (région), Massachusetts, Nouvelle-Galles du Sud, Victoria (État), Écosse, Østlandet
- Boston, Glasgow, Melbourne, Nancy, Oslo, Sydney, Vandoeuvre les Nancy, Washington (district de Columbia)
- Université de Glasgow, Université de Lorraine
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT</title><author><name sortKey="Inglis, Sally C" sort="Inglis, Sally C" uniqKey="Inglis S" first="Sally C." last="Inglis">Sally C. Inglis</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>BHF Glasgow Cardiovascular Research Centre, University of Glasgow</s1><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Preventative Health, Baker IDI Heart and Diabetes Institute</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>1 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Faculty of Nursing, Midwifery and Health, University of Technology, Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Bebchuk, Judith" sort="Bebchuk, Judith" uniqKey="Bebchuk J" first="Judith" last="Bebchuk">Judith Bebchuk</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Statistics Collaborative Inc.</s1><s2>Washington DC</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Washington (district de Columbia)</settlement><region type="state">District de Columbia</region></placeName></affiliation></author><author><name sortKey="Al Suhaim, Sultan A" sort="Al Suhaim, Sultan A" uniqKey="Al Suhaim S" first="Sultan A." last="Al-Suhaim">Sultan A. Al-Suhaim</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>BHF Glasgow Cardiovascular Research Centre, University of Glasgow</s1><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author><author><name sortKey="Case, Jessica" sort="Case, Jessica" uniqKey="Case J" first="Jessica" last="Case">Jessica Case</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Statistics Collaborative Inc.</s1><s2>Washington DC</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Washington (district de Columbia)</settlement><region type="state">District de Columbia</region></placeName></affiliation></author><author><name sortKey="Pfeffer, Marc A" sort="Pfeffer, Marc A" uniqKey="Pfeffer M" first="Marc A." last="Pfeffer">Marc A. Pfeffer</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Department of Medicine, Brigham and Women's Hospital, Harvard Medical School</s1><s2>Boston</s2><s3>USA</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Boston</settlement><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Solomon, Scott D" sort="Solomon, Scott D" uniqKey="Solomon S" first="Scott D." last="Solomon">Scott D. Solomon</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Department of Medicine, Brigham and Women's Hospital, Harvard Medical School</s1><s2>Boston</s2><s3>USA</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Boston</settlement><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Yingxin Hou" sort="Yingxin Hou" uniqKey="Yingxin Hou" last="Yingxin Hou">YINGXIN HOU</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Statistics Collaborative Inc.</s1><s2>Washington DC</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Washington (district de Columbia)</settlement><region type="state">District de Columbia</region></placeName></affiliation></author><author><name sortKey="Pitt, Bertram" sort="Pitt, Bertram" uniqKey="Pitt B" first="Bertram" last="Pitt">Bertram Pitt</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Department of Medicine, University of Michigan</s1><s2>Ann Arbor</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Ann Arbor</wicri:noRegion></affiliation></author><author><name sortKey="Dargie, Henry J" sort="Dargie, Henry J" uniqKey="Dargie H" first="Henry J." last="Dargie">Henry J. Dargie</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Cardiology Department, Western Infirmary</s1><s2>Glasgow</s2><s3>GBR</s3><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Glasgow</wicri:noRegion></affiliation></author><author><name sortKey="Ford, Ian" sort="Ford, Ian" uniqKey="Ford I" first="Ian" last="Ford">Ian Ford</name><affiliation wicri:level="4"><inist:fA14 i1="08"><s1>Robertson Centre for Biostatistics, University of Glasgow</s1><s2>Glasgow</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author><author><name sortKey="Kjekshus, John" sort="Kjekshus, John" uniqKey="Kjekshus J" first="John" last="Kjekshus">John Kjekshus</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Department of Cardiology, Oslo University Hospital</s1><s2>Oslo</s2><s3>NOR</s3><sZ>11 aut.</sZ></inist:fA14><country>Norvège</country><placeName><settlement type="city">Oslo</settlement><region nuts="2">Østlandet</region></placeName></affiliation></author><author><name sortKey="Zannad, Faiez" sort="Zannad, Faiez" uniqKey="Zannad F" first="Faiez" last="Zannad">Faiez Zannad</name><affiliation wicri:level="4"><inist:fA14 i1="10"><s1>INSERM, CIC9501 and U961, CHU Nancy, Hypertension and Heart Failure Unit, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine</s1><s2>54500 Vandoeuvre les Nancy</s2><s3>FRA</s3><sZ>12 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Grand Est</region><region type="old region" nuts="2">Lorraine (région)</region><settlement type="city">Vandoeuvre les Nancy</settlement><settlement type="city">Nancy</settlement></placeName><orgName type="university">Université de Lorraine</orgName></affiliation></author><author><name sortKey="Dickstein, Kenneth" sort="Dickstein, Kenneth" uniqKey="Dickstein K" first="Kenneth" last="Dickstein">Kenneth Dickstein</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Stavanger University Hospital, Department of Cardiology</s1><s2>Stavanger</s2><s3>NOR</s3><sZ>13 aut.</sZ></inist:fA14><country>Norvège</country><wicri:noRegion>Stavanger</wicri:noRegion></affiliation></author><author><name sortKey="Mcmurray, John J V" sort="Mcmurray, John J V" uniqKey="Mcmurray J" first="John J. V." last="Mcmurray">John J. V. Mcmurray</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>BHF Glasgow Cardiovascular Research Centre, University of Glasgow</s1><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0353768</idno><date when="2013">2013</date><idno type="stanalyst">PASCAL 13-0353768 INIST</idno><idno type="RBID">Pascal:13-0353768</idno><idno type="wicri:Area/PascalFrancis/Corpus">000724</idno><idno type="wicri:Area/PascalFrancis/Curation">005766</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000732</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000732</idno><idno type="wicri:doubleKey">0167-5273:2013:Inglis S:peripheral:artery:disease</idno><idno type="wicri:Area/Main/Merge">004F06</idno><idno type="wicri:Area/Main/Curation">004D53</idno><idno type="wicri:Area/Main/Exploration">004D53</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT</title><author><name sortKey="Inglis, Sally C" sort="Inglis, Sally C" uniqKey="Inglis S" first="Sally C." last="Inglis">Sally C. Inglis</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>BHF Glasgow Cardiovascular Research Centre, University of Glasgow</s1><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Preventative Health, Baker IDI Heart and Diabetes Institute</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>1 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Faculty of Nursing, Midwifery and Health, University of Technology, Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Bebchuk, Judith" sort="Bebchuk, Judith" uniqKey="Bebchuk J" first="Judith" last="Bebchuk">Judith Bebchuk</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Statistics Collaborative Inc.</s1><s2>Washington DC</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Washington (district de Columbia)</settlement><region type="state">District de Columbia</region></placeName></affiliation></author><author><name sortKey="Al Suhaim, Sultan A" sort="Al Suhaim, Sultan A" uniqKey="Al Suhaim S" first="Sultan A." last="Al-Suhaim">Sultan A. Al-Suhaim</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>BHF Glasgow Cardiovascular Research Centre, University of Glasgow</s1><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author><author><name sortKey="Case, Jessica" sort="Case, Jessica" uniqKey="Case J" first="Jessica" last="Case">Jessica Case</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Statistics Collaborative Inc.</s1><s2>Washington DC</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Washington (district de Columbia)</settlement><region type="state">District de Columbia</region></placeName></affiliation></author><author><name sortKey="Pfeffer, Marc A" sort="Pfeffer, Marc A" uniqKey="Pfeffer M" first="Marc A." last="Pfeffer">Marc A. Pfeffer</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Department of Medicine, Brigham and Women's Hospital, Harvard Medical School</s1><s2>Boston</s2><s3>USA</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Boston</settlement><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Solomon, Scott D" sort="Solomon, Scott D" uniqKey="Solomon S" first="Scott D." last="Solomon">Scott D. Solomon</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Department of Medicine, Brigham and Women's Hospital, Harvard Medical School</s1><s2>Boston</s2><s3>USA</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Boston</settlement><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Yingxin Hou" sort="Yingxin Hou" uniqKey="Yingxin Hou" last="Yingxin Hou">YINGXIN HOU</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Statistics Collaborative Inc.</s1><s2>Washington DC</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><settlement type="city">Washington (district de Columbia)</settlement><region type="state">District de Columbia</region></placeName></affiliation></author><author><name sortKey="Pitt, Bertram" sort="Pitt, Bertram" uniqKey="Pitt B" first="Bertram" last="Pitt">Bertram Pitt</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Department of Medicine, University of Michigan</s1><s2>Ann Arbor</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Ann Arbor</wicri:noRegion></affiliation></author><author><name sortKey="Dargie, Henry J" sort="Dargie, Henry J" uniqKey="Dargie H" first="Henry J." last="Dargie">Henry J. Dargie</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Cardiology Department, Western Infirmary</s1><s2>Glasgow</s2><s3>GBR</s3><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Glasgow</wicri:noRegion></affiliation></author><author><name sortKey="Ford, Ian" sort="Ford, Ian" uniqKey="Ford I" first="Ian" last="Ford">Ian Ford</name><affiliation wicri:level="4"><inist:fA14 i1="08"><s1>Robertson Centre for Biostatistics, University of Glasgow</s1><s2>Glasgow</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author><author><name sortKey="Kjekshus, John" sort="Kjekshus, John" uniqKey="Kjekshus J" first="John" last="Kjekshus">John Kjekshus</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Department of Cardiology, Oslo University Hospital</s1><s2>Oslo</s2><s3>NOR</s3><sZ>11 aut.</sZ></inist:fA14><country>Norvège</country><placeName><settlement type="city">Oslo</settlement><region nuts="2">Østlandet</region></placeName></affiliation></author><author><name sortKey="Zannad, Faiez" sort="Zannad, Faiez" uniqKey="Zannad F" first="Faiez" last="Zannad">Faiez Zannad</name><affiliation wicri:level="4"><inist:fA14 i1="10"><s1>INSERM, CIC9501 and U961, CHU Nancy, Hypertension and Heart Failure Unit, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine</s1><s2>54500 Vandoeuvre les Nancy</s2><s3>FRA</s3><sZ>12 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Grand Est</region><region type="old region" nuts="2">Lorraine (région)</region><settlement type="city">Vandoeuvre les Nancy</settlement><settlement type="city">Nancy</settlement></placeName><orgName type="university">Université de Lorraine</orgName></affiliation></author><author><name sortKey="Dickstein, Kenneth" sort="Dickstein, Kenneth" uniqKey="Dickstein K" first="Kenneth" last="Dickstein">Kenneth Dickstein</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Stavanger University Hospital, Department of Cardiology</s1><s2>Stavanger</s2><s3>NOR</s3><sZ>13 aut.</sZ></inist:fA14><country>Norvège</country><wicri:noRegion>Stavanger</wicri:noRegion></affiliation></author><author><name sortKey="Mcmurray, John J V" sort="Mcmurray, John J V" uniqKey="Mcmurray J" first="John J. V." last="Mcmurray">John J. V. Mcmurray</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>BHF Glasgow Cardiovascular Research Centre, University of Glasgow</s1><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author></analytic><series><title level="j" type="main">International journal of cardiology</title><title level="j" type="abbreviated">Int. j. cardiol.</title><idno type="ISSN">0167-5273</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">International journal of cardiology</title><title level="j" type="abbreviated">Int. j. cardiol.</title><idno type="ISSN">0167-5273</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Artery</term><term>Cardiology</term><term>Cardiovascular disease</term><term>Disease</term><term>Evidence-based medicine</term><term>Evolution</term><term>Heart failure</term><term>Human</term><term>Individual</term><term>Metaanalysis</term><term>Myocardial infarction</term><term>Patient</term><term>Prognosis</term><term>Vascular disease</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Infarctus du myocarde</term><term>Pathologie des vaisseaux sanguins</term><term>Insuffisance cardiaque</term><term>Pathologie de l'appareil circulatoire</term><term>Artère</term><term>Maladie</term><term>Pronostic</term><term>Evolution</term><term>Homme</term><term>Individu</term><term>Malade</term><term>Métaanalyse</term><term>Médecine factuelle</term><term>Cardiologie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Maladie</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Norvège</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>District de Columbia</li><li>Grand Est</li><li>Lorraine (région)</li><li>Massachusetts</li><li>Nouvelle-Galles du Sud</li><li>Victoria (État)</li><li>Écosse</li><li>Østlandet</li></region><settlement><li>Boston</li><li>Glasgow</li><li>Melbourne</li><li>Nancy</li><li>Oslo</li><li>Sydney</li><li>Vandoeuvre les Nancy</li><li>Washington (district de Columbia)</li></settlement><orgName><li>Université de Glasgow</li><li>Université de Lorraine</li></orgName></list><tree><country name="Royaume-Uni"><region name="Écosse"><name sortKey="Inglis, Sally C" sort="Inglis, Sally C" uniqKey="Inglis S" first="Sally C." last="Inglis">Sally C. Inglis</name></region><name sortKey="Al Suhaim, Sultan A" sort="Al Suhaim, Sultan A" uniqKey="Al Suhaim S" first="Sultan A." last="Al-Suhaim">Sultan A. Al-Suhaim</name><name sortKey="Dargie, Henry J" sort="Dargie, Henry J" uniqKey="Dargie H" first="Henry J." last="Dargie">Henry J. Dargie</name><name sortKey="Ford, Ian" sort="Ford, Ian" uniqKey="Ford I" first="Ian" last="Ford">Ian Ford</name><name sortKey="Mcmurray, John J V" sort="Mcmurray, John J V" uniqKey="Mcmurray J" first="John J. V." last="Mcmurray">John J. V. Mcmurray</name></country><country name="Australie"><region name="Victoria (État)"><name sortKey="Inglis, Sally C" sort="Inglis, Sally C" uniqKey="Inglis S" first="Sally C." last="Inglis">Sally C. Inglis</name></region><name sortKey="Inglis, Sally C" sort="Inglis, Sally C" uniqKey="Inglis S" first="Sally C." last="Inglis">Sally C. Inglis</name></country><country name="États-Unis"><region name="District de Columbia"><name sortKey="Bebchuk, Judith" sort="Bebchuk, Judith" uniqKey="Bebchuk J" first="Judith" last="Bebchuk">Judith Bebchuk</name></region><name sortKey="Case, Jessica" sort="Case, Jessica" uniqKey="Case J" first="Jessica" last="Case">Jessica Case</name><name sortKey="Pfeffer, Marc A" sort="Pfeffer, Marc A" uniqKey="Pfeffer M" first="Marc A." last="Pfeffer">Marc A. Pfeffer</name><name sortKey="Pitt, Bertram" sort="Pitt, Bertram" uniqKey="Pitt B" first="Bertram" last="Pitt">Bertram Pitt</name><name sortKey="Solomon, Scott D" sort="Solomon, Scott D" uniqKey="Solomon S" first="Scott D." last="Solomon">Scott D. Solomon</name><name sortKey="Yingxin Hou" sort="Yingxin Hou" uniqKey="Yingxin Hou" last="Yingxin Hou">YINGXIN HOU</name></country><country name="Norvège"><region name="Østlandet"><name sortKey="Kjekshus, John" sort="Kjekshus, John" uniqKey="Kjekshus J" first="John" last="Kjekshus">John Kjekshus</name></region><name sortKey="Dickstein, Kenneth" sort="Dickstein, Kenneth" uniqKey="Dickstein K" first="Kenneth" last="Dickstein">Kenneth Dickstein</name></country><country name="France"><region name="Grand Est"><name sortKey="Zannad, Faiez" sort="Zannad, Faiez" uniqKey="Zannad F" first="Faiez" last="Zannad">Faiez Zannad</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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