Author + information
- Christoph Olivier1,
- William Hiatt2,
- Daniel Wojdyla3,
- Schuyler Jones3,
- Frank Rockhold3,
- Jeffrey Berger4,
- Brian Katona5,
- Lars Norgren6,
- Juuso Blomster7 and
- Manesh Patel3
- 1Stanford University School of Medicine, Stanford, California, United States
- 2University of Colorado School of Medicine, Aurora, Colorado, United States
- 3Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, United States
- 4Departments of Medicine and Surgery, New York University School of Medicine, New York, New York, United States
- 5AstraZeneca, West Chester, Delaware, United States
- 6Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- 7AstraZeneca, Gothenburg, Molndal, Sweden
Patients with peripheral artery disease (PAD) are at high risk for myocardial infarction (MI). The characterization of types of MI has not been reported. This analysis aims to characterize types of MI in patients with PAD and the clinical and demographic features of patients with and without MI.
Data of patients enrolled in the EUCLID trial (NCT01732822) were included. Eligible participants had an ankle–brachial index (ABI) of 0.80 or less or had undergone revascularization of the lower limbs. MI type was characterized by a central adjudication committee: by type (Type 1 spontaneous, Type 2 secondary, Type 3 sudden cardiac death, Type 4a <48h post-PCI, Type 4b definite stent thrombosis, Type 5 <72h post-CABG) or by ECG changes (STEMI, NSTEMI).
13,885 patients were randomized and followed for a median of 30 months. MI occurred in 683 patients (4.9%; 2.4 MIs per 100 patient-years). Patients experiencing MI were older (median 69 vs 66 years; p<0.001), more likely to have diabetes mellitus (51 vs 38%; p<0.001) or a previous revascularization (68 vs 56%; p<0.001) and had a lower ABI (if included by ABI: mean [SD] 0.60 [0.13] vs 0.63 [0.15]; p<0.01) compared with patients without MI. MI types are shown in Figure 1. Of MIs, 9.2% were STEMI, 76.4% were NSTEMI, and 14.4% unknown.
One out of 20 patients with symptomatic PAD suffered MI during follow-up. Type 1 (spontaneous) was the most common MI type; however, one-third of MIs were Type 2 (secondary). NSTEMI occurred more frequently than STEMI. More work is necessary to understand independent predictors of MI and MI types in this population.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention