Impact of pre-existing vascular disease on clinical outcomes in patients with non-ST-segment myocardial infarction: a nationwide cohort study.

AIMS: Little is known about the outcomes and processes of care of patients with non ST-segment myocardial infarction (NSTEMI) who present with 'polyvascular' disease. METHODS AND RESULTS: We analysed 287,279 NSTEMI patients using the Myocardial Infarction National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analysed according to history of affected vascular bed; coronary artery disease (CAD), cerebrovascular disease (CeVD) and peripheral vascular disease (PVD), with comparison to a historically disease-free control group; comprising 167,947 patients (59%). After adjusting for demographics and management, polyvascular disease was associated with increased likelihood of major adverse cardiovascular events (MACE) (CAD OR: 1.06, 95% CI: 1.01-1.12, P = 0.02) (CeVD OR: 1.19, 95% CI: 1.12-1.27, P<0.001) (PVD OR: 1.22, 95% CI: 1.13-1.33, P<0.001) and in-hospital mortality (CeVD OR: 1.24, 95% CI: 1.16-1.32, P<0.001) (PVD OR: 1.33, 95% CI: 1.21-1.46, P<0.001). Patients without vascular disease were less frequently discharged on statins (PVD 88%, CeVD 86%, CAD 90% and control 78%), and those with moderate (ejection fraction (EF) 30-49%) or severe left ventricular systolic dysfunction (LVSD) (EF