240 Long-term pronostic value of peripheral vascular disease in patients undergoing isolated coronary artery bypass grafting

Abstract

The concept of global vascular risk is recognized as an important predictor of major events in patients with coronary artery disease. We aimed to evaluate long term clinical outcome among patients with peripheral vascular disease (PVD) following coronary artery bypass grafting. We studied 589 consecutive patients who underwent isolated coronary artery bypass grafting between January 2003 and June 2005. The impact of peripheral artery disease was assessed by comparing a two year follow-up of 2 groups of patients: patients with (n=243) and without (n=346) PVD. Patients with PVD were significantly older (70±9 vs 64±11 years p<0.001) and were more often men (80.3% vs 74.2% p=0.04) than those without PVD. They had a higher incidence of hypertension (p=0.002), chronic renal dysfunction (p<0.01), chronic pulmonary disease (p=0.005) with higher EuroSCORE cardiac risk (9.6±6 vs 3.8±3 p<0.01). No significant difference was noted between the 2 groups with regard to left ventricular ejection fraction. The analysis of ischemic events showed that peripheral ischemic events (19.7% vs 4.6% p<0.001) and more specifically cerebrovascular events (9% vs 3.5% p<0.01) were significantly higher in PVD group. Neither myocardial infarction (6.2% vs 6.7% p=ns) nor new coronary revascularization (9.8% vs 14.5% p=ns) differed significantly among the 2 groups; The two-year follow up showed a rate of survival markedly lower for patents with PVD than those with isolated coronary disease. Two-year cumulative survival rates were 76.6% for patients with PVD and 94.1% for those with isolated coronary disease (p<0.001). Differences in outcome remained significant after adjusting all variables including medical treatment, PVD appeared as an independent predictive factor of all cause mortality with a hazard ration of 3.2 [95%CI (1.8-5.7) p<0.001]. PVD was not only highly prevalent but also strongly associated with long term mortality after coronary artery bypass surgery.