Outcomes of acute coronary syndrome patients with concurrent extra-cardiac vascular disease in the era of transradial coronary intervention: A retrospective multicenter cohort study

BackgroundExtra-cardiac vascular diseases (ECVDs), such as cerebrovascular disease (CVD) or peripheral arterial disease (PAD), are frequently observed among patients with acute coronary syndrome (ACS). However, it is not clear how these conditions affect patient outcomes in the era of transradial coronary intervention (TRI).Methods and resultsAmong 7,980 patients with ACS whose data were extracted from the multicenter Japanese percutaneous coronary intervention (PCI) registry between August 2008 and March 2017, 888 (11.1%) had one concurrent ECVD (either PAD [345 patients: 4.3%] or CVD [543 patients; 6.8%]), while 87 patients (1.1%) had both PAD and CVD. Overall, the presence of ECVD was associated with a higher risk of mortality (odds ratio [OR]: 1.728; 95% confidence interval [CI]: 1.183–2.524) and bleeding complications (OR: 1.430; 95% CI: 1.028–2.004). There was evidence of interaction between ECVD severity and procedural access site on bleeding complication on the additive scale (relative excess risk due to interaction: 0.669, 95% CI: -0.563–1.900) and on the multiplicative scale (OR: 2.105; 95% CI: 1.075–4.122). While the incidence of death among patients with ECVD remained constant during the study period, bleeding complications among patients with ECVD rapidly decreased from 2015 to 2017, in association with the increasing number of TRI.ConclusionsOverall, the presence of ECVD was a risk factor for adverse outcomes after PCI for ACS, both mortality and bleeding complications. In the most recent years, the incidence of bleeding complications among patients with ECVD decreased significantly coinciding with the rapid increase of TRI.背景：心外血管疾病（Extra-cardiac vascular diseases, ECVDs），如脑血管疾病（cerebrovascular disease, CVD）或外周动脉疾病（peripheral arterial disease, PAD），在急性冠脉综合征（acute coronary syndrome, ACS）患者中较为多见。然而，在经桡动脉冠状动脉介入治疗（transradial coronary intervention, TRI）时代，此类疾病如何影响患者预后仍不明确。 研究方法与结果：本研究从2008年8月至2017年3月的多中心日本经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）登记库中提取了7980例ACS患者的临床数据，其中888例（11.1%）合并1种ECVD（外周动脉疾病患者345例，占比4.3%；脑血管疾病患者543例，占比6.8%），另有87例（1.1%）同时合并PAD与CVD。总体而言，合并ECVD与更高的死亡风险显著相关[比值比（odds ratio, OR）=1.728；95%置信区间（confidence interval, CI）：1.183~2.524]，同时也与出血并发症风险升高相关（OR=1.430；95%CI：1.028~2.004）。在相加模型尺度上，ECVD严重程度与手术入路位点在出血并发症方面存在交互作用[交互作用相对超额危险度=0.669，95%CI：-0.563~1.900]；在相乘模型尺度上，二者的交互作用同样具有统计学意义（OR=2.105；95%CI：1.075~4.122）。研究期间，合并ECVD患者的死亡发生率保持稳定，但该类患者的出血并发症发生率在2015年至2017年间快速下降，这与TRI手术量的持续增长密切相关。 结论：总体而言，合并ECVD是ACS患者接受PCI治疗后不良预后（包括死亡与出血并发症）的危险因素。近年来，随着TRI手术的快速普及，合并ECVD患者的出血并发症发生率已出现显著下降。