{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:23:26Z","timestamp":1760059406525,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Atherothrombosis is a systemic disease that may affect one or more than one vascular bed. Data on the impact of polyvascular disease (PVD) on the long-term prognosis of patients with coronary artery disease (CAD) are still scarce. Aim: To assess the prevalence of symptomatic PVD in a cohort of patients with a new episode of acute coronary syndrome (ACS) and to investigate the impact of multiple vascular beds involvement on long-term outcomes. Methods: We analysed a nationwide, comprehensive administrative database of consecutive patients aged \u2265 40 years admitted for a new episode of ACS in Italy in 2017\u20132018. Patients with ACS were stratified according to the presence of peripheral artery disease (PAD) only; cerebrovascular disease (CeVD) only; PAD+CeVD; or neither (no PAD\/noCeVD, i.e., ACS only). A multivariate Cox proportional hazards model was used to assess the impact of PAD only; CeVD only and PAD+CeVD on 5-year MACCE. Results: A total of 342,052 patients hospitalised with ACS were identified. Among them, 24,727 (7.2%) were patients with PAD only, 16,887 (4.9%) with CeVD only, and 5810 (1.7%) with PAD+CeVD. After adjusting for age, sex, and comorbidities, the hazard ratio (HR) for 5-year MACCE was 1.37 (95% CI: 1.35\u20131.40), 1.36 (95% CI: 1.33\u20131.39), and 1.45 (95% CI: 1.40\u20131.50) in patients with PAD only, CeVD only, and PAD+CeVD, respectively, compared with patients with ACS only. Conclusions: In patients with ACS, the involvement of a second vascular bed increases the risk of long-term outcomes; the simultaneous involvement of three vascular beds further increases the risk of long-term outcomes.<\/jats:p>","DOI":"10.3390\/jcm14124158","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T11:18:40Z","timestamp":1749640720000},"page":"4158","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Polyvascular Disease on Long-Term Prognosis of Patients with Acute Coronary Syndrome\u2014A Retrospective Cohort Study in Italy"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3340-7865","authenticated-orcid":false,"given":"Gian Francesco","family":"Mureddu","sequence":"first","affiliation":[{"name":"Cardiac Rehabilitation Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy"},{"name":"ITACARE-P (Italian Alliance for Cardiovascular Rehabilitation and Prevention), 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6690-5537","authenticated-orcid":false,"given":"Stefano","family":"Rosato","sequence":"additional","affiliation":[{"name":"National Center for Global Health, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3174-4278","authenticated-orcid":false,"given":"Paola","family":"D\u2019Errigo","sequence":"additional","affiliation":[{"name":"National Center for Global Health, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7997-6908","authenticated-orcid":false,"given":"Pompilio","family":"Faggiano","sequence":"additional","affiliation":[{"name":"ITACARE-P (Italian Alliance for Cardiovascular Rehabilitation and Prevention), 21100 Varese, Italy"},{"name":"Cardiology Unit Poliambulanza Foundation, 25124 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Ciccarelli","sequence":"additional","affiliation":[{"name":"Scientific Secretariat of the Presidency, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0562-4923","authenticated-orcid":false,"given":"Gabriella","family":"Badoni","sequence":"additional","affiliation":[{"name":"National Center for Global Health, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9878-4565","authenticated-orcid":false,"given":"Marco","family":"Ambrosetti","sequence":"additional","affiliation":[{"name":"ITACARE-P (Italian Alliance for Cardiovascular Rehabilitation and Prevention), 21100 Varese, Italy"},{"name":"Cardiac Rehabilitation Unit, Crema Hospital, 26013 Cremona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1345-0284","authenticated-orcid":false,"given":"Francesco","family":"Fattirolli","sequence":"additional","affiliation":[{"name":"ITACARE-P (Italian Alliance for Cardiovascular Rehabilitation and Prevention), 21100 Varese, Italy"},{"name":"Department of Clinical and Experimental Medicine, University of Firenze, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8313-794X","authenticated-orcid":false,"given":"Giovanni","family":"Baglio","sequence":"additional","affiliation":[{"name":"Italian National Agency for Regional Healthcare Services, 00187 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e347","DOI":"10.1161\/CIR.0000000000001209","article-title":"2024 Heart Disease and Stroke Statistics: A Report of US and Global Data from the American Heart Association","volume":"149","author":"Martin","year":"2024","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e721","DOI":"10.1016\/S2214-109X(20)30117-0","article-title":"Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: A systematic review, meta-analysis, and modelling study","volume":"8","author":"Song","year":"2020","journal-title":"Lancet Glob. 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