Evaluation of Long-Term Cardiovascular Outcomes in Patients With NSTEMI Undergoing Percutaneous Coronary Intervention: Impact of Comorbid Peripheral Artery Disease.

Abstract

The present study evaluated the long-term prognostic impact of comorbid peripheral artery disease (PAD) in non-ST-elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). We analyzed data from 1245 NSTEMI patients who underwent PCI between 2013 and 2022. PAD was identified from electronic health records based on an ankle-brachial index <0.9 or prior lower extremity revascularization. The primary outcome was major adverse cardiovascular events (MACE), including all-cause mortality, recurrent myocardial infarction, stroke, and heart failure hospitalization (mean follow-up: 8.2 years). Kaplan-Meier survival analysis and Cox proportional hazards regression were adjusted for age, gender, diabetes, hypertension, and creatinine levels. Of 1245 patients, 312 (25.1%) had PAD and were older (68.4 ± 9.2 vs 62.7 ± 10.1 years, P < .001) and had higher rates of diabetes (48% vs 32%, P = .002) and hypertension (76% vs 61%, P = .01). MACE occurred in 42.3% of PAD patients versus 25.6% in those without PAD (P < .001). Kaplan-Meier analysis showed reduced MACE-free survival in PAD patients (log-rank P < .001). Cox regression confirmed PAD as an independent predictor of MACE (hazard ratio: 1.78, 95% CI 1.45-2.19, P < .001). In NSTEMI patients post-PCI, PAD significantly increased long-term MACE risk, replicating worse outcomes observed in polyvascular disease and underscoring the need for enhanced risk stratification of this cohort.