Background:
Polyvascular disease (PVD) is defined as the presence of atherosclerotic lesions in more than one vascular territory and it is an independent indicator of increased mortality and morbidity. Prior studies in the Gulf region have demonstrated a low prevalence of PVD in acute coronary syndrome (ACS) patients. However, we believe that the use of inconsistent cut-offs for defining ankle-brachial index (ABI) and the lack of nationwide registry database grossly underestimates the true prevalence.
Methods:
Data from 549 adults who presented with an initial diagnosis of ACS at our hospital, from January 2015 to December 2018, was reviewed retrospectively. We evaluated peripheral artery disease and cerebrovascular disease using ABI and carotid duplex. An ABI value of <0.9 or >1.4 and carotid stenosis > 60 % were considered abnormal.
Results:
15% (n = 82) of patients had PVD. Gender and body mass index were comparable in both groups. In contrast to non-PVD patients, patients with PVD were older (62 vs. 51 years, p = 0.01), had a higher prevalence of diabetes mellitus (73 vs. 48 %, p < 0.001), hypertension (78 vs. 58 %, p < 0.001), dyslipidemia (73 vs. 60 %, p = 0.02), chronic kidney disease (21 vs. 8 %, p < 0.001), and history of stroke (13 vs. 3 %, p < 0.001). Further, more patients with PVD underwent coronary artery bypass grafting (66 vs. 31 %, p < 0.001) and had intra-aortic balloon pump insertion (10 vs. 4 %, p = 0.04). Medical management including use of thrombolytics, statins, and antiplatelet was not significantly different in both the groups. After adjustment, PVD was associated with an increased likelihood (aOR, 3.40; p = 0.01) of acute myocardial infarction at 1-year follow-up.
Conclusions:
Since the progression of atherosclerosis is an insidious process, most patients remain asymptomatic before presenting with major life-threatening vascular events. We recommend regular screening for vascular disease with noninvasive techniques like ABI in high-risk patients. It is important that physicians are aware of the impact of PVD in our region and aggressively manage these patients with lifestyle modifications and pharmacological interventions. Further, a high prevalence of risk factors in the Gulf countries necessitates redefining ABI cut off values.