Coronary artery disease
Comparison of Two-Year Outcomes in Patients Undergoing Isolated Coronary Artery Bypass Grafting With and Without Peripheral Artery Disease

https://doi.org/10.1016/j.amjcard.2009.07.001Get rights and content

We aimed to evaluate the long-term clinical outcomes among patients with peripheral arterial disease (PAD) after coronary artery bypass grafting. We studied 589 consecutive patients who had undergone isolated coronary artery bypass grafting from January 2003 to June 2005 at our university hospital. The effect of PAD was assessed by comparing the 2-year follow-up data from 2 groups of patients: 243 patients with and 346 without PAD. A large systematic atherosclerosis screening was performed, including cerebrovascular disease, lower extremity artery disease, and abdominal aorta disease and its branches. PAD was defined as a history of treated atherosclerotic disease and significant atherosclerotic stenosis on screening. Patients with PAD were significantly older (70 ± 9 vs 64 ± 11 years, p <0.001) and were more often men (p = 0.04) than those without PAD. They had a greater incidence of hypertension (p = 0.002), chronic renal dysfunction (p <0.01), chronic pulmonary disease (p = 0.005), and a history of coronary artery disease (p = 0.03). No significant difference was noted between the 2 groups with regard to the left ventricular ejection fraction. The 2-year cumulative survival rate was 76.6% for patients with PAD and 94.1% for those with isolated coronary disease (p <0.001). In conclusion, after adjusting all significant variables, the presence of PAD appeared as an independent predictive factor for all-cause mortality (adjusted hazard ratio 3.2, 95% confidence interval 1.8 to 5.7, p = 0.001).

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Methods

From 2003 to 2005, 589 consecutive patients underwent isolated CABG at our center. Coronary artery disease was defined as a reduction of the vessel diameter by ≥70% in 1 view on coronary angiography. The presence of stenosis >70% in the left anterior descending, circumflex, or right coronary systems was used as the criterion for single-, double-, or triple-vessel disease. Patients who underwent concomitant repair of valves, cardiac rupture, a ventricular aneurysm, or an ascendant aorta were

Results

Of the 589 patients undergoing isolated CABG, PAD was identified in 243 (40%; Table 1). The extent of PAD was diffuse: 39.1% of patients in the PAD group presented with ≥2 noncoronary artery disease localizations. Patients with PAD were significantly older (70 ± 9 vs 64 ± 11 years, p <0.001) and were more often men (p = 0.04) than those without PAD. They more often had hypertension (p = 0.002) chronic renal dysfunction (p <0.01), chronic obstructive pulmonary disease (p = 0.005), and a history

Discussion

The presence of multifocal vascular disease is an indicator of an advanced stage of atherosclerosis, and our results have confirmed that rigorous and systematic screening for the presence of PAD allows better stratification of the postoperative and long-term risk of CABG.3, 4, 5, 6, 8, 9 Our results showed a very high prevalence of PAD (40%), explained by the inclusion of different manifestations of atherosclerosis. Moreover, our study is the first to include global abdominal vascular disease

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