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

Published:September 28, 2009DOI:https://doi.org/10.1016/j.amjcard.2009.07.001
      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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      References

        • Naidu S.S.
        • Vlachos H.
        • Faxon D.
        • Jacobs A.K.
        • Selzer F.
        • Detre K.
        • Wilensky R.L.
        Usefulness of noncoronary vascular disease in predicting adverse events in the year following percutaneous coronary intervention.
        Am J Cardiol. 2005; 95: 575-580
        • Steg P.G.
        • Bhatt D.L.
        • Wilson P.W.
        • D'Agostino R.I.
        • Ohman E.M.
        • Röther J.
        • Liau C.S.
        • Hirsch A.T.
        • Mas J.L.
        • Ikeda Y.
        • Pencina M.J.
        • Goto S.
        • REACH Registry Investigators
        One-year cardiovascular event rates in outpatients with atherothrombosis.
        JAMA. 2007; 297: 1197-1206
        • Birkmeyer J.D.
        • O'Connor G.T.
        • Quinton H.B.
        • Ricci M.A.
        • Morton J.R.
        • Leavitt B.J.
        • Charlesworth D.C.
        • Hernandez F.
        • McDaniel M.D.
        • Northern New England Cardiovascular Disease Study Group
        The effect of peripheral vascular disease on in-hospital mortality rates with coronary artery bypass surgery.
        J Vasc Surg. 1995; 21: 445-452
        • Mesh C.L.
        • Cmolik B.L.
        • Van Heekeren D.W.
        • Lee J.H.
        • Whittlesey D.
        • Graham L.M.
        • Geha A.S.
        • Bowlin S.J.
        Coronary bypass in vascular patients: a relatively high-risk procedure.
        Ann Vasc Surg. 1997; 11: 612-619
        • Eagle K.A.
        • Rihal C.S.
        • Foster E.D.
        • Mickel M.C.
        • Gersh B.J.
        • Coronary Artery Surgery Study (CASS) Investigators
        Long-term survival in patients with coronary artery disease: importance of peripheral vascular disease.
        J Am Coll Cardiol. 1994; 23: 1091-1095
        • Sutton-Tyrrell K.
        • Rihal C.
        • Sellers M.A.
        • Burek K.
        • Trudel J.
        • Roubin G.
        • Brooks M.M.
        • Grogan M.
        • Sopko G.
        • Keller N.
        • Jandová R.
        Long-term prognostic value of clinically evident noncoronary vascular disease in patients undergoing coronary revascularization in the Bypass Angioplasty Revascularization Investigation (BARI).
        Am J Cardiol. 1998; 81: 375-381
        • Saw J.
        • Bhatt D.L.
        • Moliterno D.J.
        • Brener S.J.
        • Steinhubl S.R.
        • Lincoff A.M.
        • Tcheng J.E.
        • Harrington R.A.
        • Simoons M.
        • Hu T.
        • Sheikh M.A.
        • Kereiakes D.J.
        • Topol E.J.
        The influence of peripheral arterial disease on outcomes: a pooled analysis of mortality in eight large randomized percutaneous coronary intervention trials.
        J Am Coll Cardiol. 2006; 48: 1567-1572
        • Burek K.A.
        • Sutton-Tyrrell K.
        • Brooks M.M.
        • Naydeck B.
        • Keller N.
        • Sellers M.A.
        • Roubin G.
        • Jandová R.
        • Rihal C.S.
        Prognostic importance of lower extremity arterial disease in patients undergoing coronary revascularization in the Bypass Angioplasty Revascularization Investigation (BARI).
        J Am Coll Cardiol. 1999; 34: 716-721
        • Aboyans V.
        • Lacroix P.
        • Postil A.
        • Guilloux J.
        • Rollé F.
        • Cornu E.
        • Laskar M.
        Subclinical peripheral arterial disease and incompressible ankle arteries are both long-term prognostic factors in patients undergoing coronary artery bypass grafting.
        J Am Coll Cardiol. 2005; 46: 815-820
        • Barandon L.
        • Richebé P.
        • Munos E.
        • Calderon J.
        • Lafitte M.
        • Lafitte S.
        • Couffinhal T.
        • Roques X.
        Off-pump coronary artery bypass surgery in very high-risk patients: adjustment and preliminary results.
        Interact Cardiovasc Thorac Surg. 2008; 7: 789-793
        • Angelini G.D.
        • Taylor F.C.
        • Reeves B.C.
        • Ascione R.
        Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials.
        Lancet. 2002; 359: 1194-1199
        • Gundry S.R.
        • Romano M.A.
        • Shattuck O.H.
        • Razzouk A.J.
        • Bailey L.L.
        Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass.
        J Thorac Cardiovasc Surg. 1998; 115: 1273-1278
        • Kuduvalli M.
        • Oo A.Y.
        • Newall N.
        • Grayson A.D.
        • Jackson M.
        • Desmond M.J.
        • Fabri B.M.
        • Rashid A.
        Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery.
        Eur J Cardiothoracic Surg. 2005; 27: 592-598
        • Koch C.G.
        • Li L.
        • Duncan A.I.
        • Mihaljevic T.
        • Cosgrove D.M.
        • Loop F.D.
        • Starr N.J.
        • Blackstone E.H.
        Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting.
        Crit Care Med. 2006; 34: 1608-1616
        • Milano C.A.
        • Kesler K.
        • Archibald N.
        • Sexton D.J.
        • Jones R.H.
        Mediastinitis after coronary artery bypass graft surgery: risk factors and long-term survival.
        Circulation. 1995; 92: 2245-2251
        • Steingrimsson S.
        • Gottfredsson M.
        • Kristinsson K.G.
        • Gudbjartsson T.
        Deep sternal wound infections following open heart surgery in Iceland: a population-based study.
        Scand Cardiovasc J. 2008; 42: 208-213
        • Braxton J.H.
        • Marrin C.A.
        • McGrath P.D.
        • Ross C.S.
        • Morton J.R.
        • Norotsky M.
        • Charlesworth D.C.
        • Lahey S.J.
        • Clough R.A.
        • O'Connor G.T.
        • Northern New England Cardiovascular Disease Study Group
        Mediastinitis and long-term survival after coronary artery bypass graft surgery.
        Ann Thorac Surg. 2000; 70: 2004-2007
        • Goto T.
        • Baba T.
        • Yoshitake A.
        • Shibata Y.
        • Ura M.
        • Sakata R.
        Craniocervical and aortic atherosclerosis as neurologic risk factors in coronary surgery.
        Ann Thorac Surg. 2000; 69: 834-840
        • Naylor A.R.
        • Mehta Z.
        • Rothwell P.M.
        • Bell P.R.
        Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature.
        Eur J Vasc Endovasc Surg. 2002; 23: 283-294
        • Sharony R.
        • Grossi E.A.
        • Saunders P.C.
        • Galloway A.C.
        • Applebaum R.
        • Ribakove G.H.
        • Culliford A.T.
        • Kanchuger M.
        • Kronzon I.
        • Colvin S.B.
        Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease.
        J Thorac Cardiovasc Surg. 2004; 127: 406-413
        • Mishra M.
        • Malhotra R.
        • Karlekar A.
        • Mishra Y.
        • Trehan N.
        Propensity case-matched analysis of off-pump versus on-pump coronary artery bypass grafting in patients with atheromatous aorta.
        Ann Thorac Surg. 2006; 82: 608-614
        • Rihal C.S.
        • Sutton-Tyrrell K.
        • Guo P.
        • Keller N.M.
        • Jandova R.
        • Sellers M.A.
        • Schaff H.V.
        • Holmes Jr, D.R.
        Increased incidence of periprocedural complications among patients with peripheral vascular disease undergoing myocardial revascularization in the bypass angioplasty revascularization investigation.
        Circulation. 1999; 100: 171-177
        • Toumpoulis I.K.
        • Anagnostopoulos C.E.
        • Chamogeorgakis T.P.
        • Angouras D.C.
        • Kariou M.A.
        • Swistel D.G.
        • Rokkas C.K.
        Impact of early and delayed stroke on in-hospital and long-term mortality after isolated coronary artery bypass grafting.
        Am J Cardiol. 2008; 102: 411-417
        • Filsoufi F.
        • Rahmanian P.B.
        • Castillo J.G.
        • Scurlock C.
        • Legnani P.E.
        • Adams D.H.
        Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery.
        Ann Surg. 2007; 246: 323-329
        • Mangi A.A.
        • Christison-Lagay E.R.
        • Torchiana D.F.
        • Warshaw A.L.
        • Berger D.L.
        Gastrointestinal complications in patients undergoing heart operation: an analysis of 8709 consecutive cardiac surgical patients.
        Ann Surg. 2005; 24: 895-904
        • Okrainec K.
        • Platt R.
        • Pilote L.
        • Eisenberg M.J.
        Cardiac medical therapy in patients after undergoing coronary artery bypass graft surgery: a review of randomized controlled trials.
        J Am Coll Cardiol. 2005; 45: 177-184
        • Mehta R.H.
        • Bhatt D.L.
        • Steg P.G.
        • Goto S.
        • Hirsch A.T.
        • Liau C.S.
        • Röther J.
        • Wilson P.W.
        • Richard A.J.
        • Eagle K.A.
        • Ohman E.M.
        • REACH Registry Investigators
        Modifiable risk factors control and its relationship with 1 year outcomes after coronary artery bypass surgery: insights from the REACH registry.
        Eur Heart J. 2008; 29: 3052-3060