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

Masaki Kodaira, Mitsuaki Sawano, Toshiki Kuno, Yohei Numasawa, Shigetaka Noma, Masahiro Suzuki, Shohei Imaeda, Ikuko Ueda, Keiichi Fukuda, Shun Kohsaka

Research output: Contribution to journalArticle

Abstract

Background Extra-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 results Among 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. Conclusions Overall, 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.

Original languageEnglish
Article numbere0223215
JournalPloS one
Volume14
Issue number10
DOIs
Publication statusPublished - 2019 Jan 1

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vascular diseases
Acute Coronary Syndrome
cohort studies
Vascular Diseases
Multicenter Studies
Heart Diseases
Cohort Studies
hemorrhage
cerebrovascular disorders
Cerebrovascular Disorders
Hemorrhage
confidence interval
Peripheral Arterial Disease
odds ratio
Confidence Intervals
Odds Ratio
Percutaneous Coronary Intervention
incidence
Mortality
Incidence

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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Outcomes of acute coronary syndrome patients with concurrent extra-cardiac vascular disease in the era of transradial coronary intervention : A retrospective multicenter cohort study. / Kodaira, Masaki; Sawano, Mitsuaki; Kuno, Toshiki; Numasawa, Yohei; Noma, Shigetaka; Suzuki, Masahiro; Imaeda, Shohei; Ueda, Ikuko; Fukuda, Keiichi; Kohsaka, Shun.

In: PloS one, Vol. 14, No. 10, e0223215, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background Extra-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 results Among 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. Conclusions Overall, 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.",
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T1 - Outcomes of acute coronary syndrome patients with concurrent extra-cardiac vascular disease in the era of transradial coronary intervention

T2 - A retrospective multicenter cohort study

AU - Kodaira, Masaki

AU - Sawano, Mitsuaki

AU - Kuno, Toshiki

AU - Numasawa, Yohei

AU - Noma, Shigetaka

AU - Suzuki, Masahiro

AU - Imaeda, Shohei

AU - Ueda, Ikuko

AU - Fukuda, Keiichi

AU - Kohsaka, Shun

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N2 - Background Extra-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 results Among 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. Conclusions Overall, 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.

AB - Background Extra-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 results Among 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. Conclusions Overall, 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.

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