Abstract Body (Do not enter title and authors here): Background: Peripheral artery disease (PAD) is associated with worse outcomes in patients with underlying coronary artery disease (CAD). While the impact of PAD in stable CAD is well-studied, data on the impact of concomitant PAD in acute coronary syndrome (ACS) patients are limited. Our meta-analysis assesses cardiovascular and clinical outcomes in ACS patients with PAD compared to those without PAD.
Methods: We conducted an extensive search using PubMed, EMBASE, and Cochrane Library for studies published prior to June 1, 2024, evaluating clinical and CV outcomes in patients diagnosed with PAD and concomitant ACS. Data were extracted and analyzed using R (v.4.3). Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) with 95% confidence intervals were used as effect measures for dichotomous variables. Our outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE), recurrent CV events, and major bleeding.
Results: We identified four studies, including 3,860,564 patients. Our inclusion criteria were adults (≥18 years) recently hospitalized or discharged with ACS (unstable angina, non-ST-elevation myocardial infarction, and ST-elevation myocardial infarction). PAD was defined as intermittent claudication and/or previous revascularization. The PAD group exhibited significantly higher likelihood of adverse outcomes compared to the non-PAD group. Specifically, the odds of mortality were significantly higher in the PAD group (OR: 2.79 [1.41, 5.53]; I2=99%; p=0.003), however there was substantial heterogeneity among the studies. The odds of MACE were also higher in the PAD group (OR: 2.12 [1.51, 2.96]; I2=71%; p<0.0001), as were the odds of recurrent CV events in the PAD group (OR: 1.72 [1.52, 1.94]; I2=0%; p<0.00001). Additionally, the PAD group had significantly increased odds of major bleeding events (OR: 2.48 [1.85, 3.33]; I2=0%; p<0.00001).
Conclusion: Our meta-analysis demonstrates that PAD significantly worsens cardiovascular and clinical outcomes in ACS patients, highlighting the need for identification and targeted management strategies in this high-risk population. Future research should focus on optimizing interventions to improve prognosis for ACS patients with PAD.