Treatment practices and outcomes of patients with established peripheral arterial disease hospitalized with acute myocardial infarction in a community setting

BACKGROUND: There are little contemporary data available describing the hospital and long-term outcomes of patients with peripheral arterial disease (PAD) who are hospitalized with acute myocardial infarction (AMI). The objectives of our population-based study were to examine the hospital and long-term outcomes, as well as the use of different treatment practices, among patients with established PAD who were hospitalized with AMI. METHODS: The study sample consisted of 4480 patients hospitalized with AMI at all Worcester, Mass, medical centers in 4 alternate years between 1997 and 2003. RESULTS: Among the metropolitan Worcester residents hospitalized with AMI, 13.5% had a history of PAD. Prior use of proven cardiac therapies in patients with, and without, PAD was less than optimal though more often used in patients with prior PAD. Patients with PAD were significantly less likely to be treated with thrombolytic therapy during hospitalization than patients without PAD. Patients with PAD were not at significantly increased risk of dying during hospitalization (adjusted OR 1.29, 0.95% CI 0.97-1.71), though they were at a significantly increased risk of dying at 1 year after hospital discharge (adjusted OR 2.00, 95% CI 1.58-2.52) in comparison with patients without prior PAD. CONCLUSIONS: Approximately 1 in 8 patients presenting with AMI in this community-wide study had a history of clinically recognized PAD. These patients are at increased risk of dying during the first year after hospital discharge. Our data indicate that there is a room for improvement for the enhanced use of effective treatment modalities and implementation of secondary prevention strategies in these high-risk patients.