Abstract
The present study was conducted to investigate whether upper-extremity vascular access (VA) creation increases the risk for major adverse cardiac events (MACE) and death in patients undergoing coronary artery bypass grafting (CABG) with an in situ left internal thoracic artery (ITA) graft. A total of 111 patients with CABG with a left ITA graft who underwent upper-extremity VA creation were analyzed retrospectively; 93 patients received left VA creation (83.8%, ipsilateral group) and 18 patients received right VA creation (16.2%, contralateral group). The primary outcome was the occurrence of MACE, and the secondary outcome was the composite of MACE or late death. There were no significant differences in the incidence of primary (P = 0.30) or secondary (P = 0.09) outcomes between the two groups. Multivariate regression analysis indicated that prior cerebrovascular accidents (hazard ratio [HR] 3.30; 95% confidence interval [CI] 1.37–7.97; P = 0.01) and type of VA (HR 3.44; 95% CI 1.34–8.82; P = 0.01) were independently associated with MACE; prior peripheral arterial occlusive disease (HR 4.22; 95% CI 1.62–10.98; P<0.01) and type of VA (arteriovenous fistula vs. prosthetic arteriovenous grafting) (HR 3.06; 95% CI, 1.42–6.61; P<0.01) were associated with the composite of MACE or death. The side and location of VA were not associated with MACE or death. Our study showed no definite evidence that ipsilateral VA creation affects the subsequent occurrence of MACE or late death from any cause. The type of VA (a prosthetic arteriovenous grafting) is a significant predictor of the subsequent occurrence of MACE or late death.
Highlights
Both chronic kidney disease (CKD) and symptomatic coronary artery disease (CAD) are associated with cardiovascular risk factors
The aims of the present study were to evaluate whether vascular access (VA) creation in the upper-extremity increases the risks of major adverse cardiac events (MACE) and late death from any cause in patients with coronary artery bypass grafting (CABG) with an in situ internal thoracic artery (ITA) graft, and to determine the clinical variables associated with MACE and late death in these patients
A total of 111 patients with CABG with an in situ left ITA graft who received upper-extremity VA creation were included in this study, and were stratified into the ipsilateral (93 patients, 83.8%; left VA creation) or contralateral (18 patients, 16.2%; right VA creation) groups based
Summary
Both chronic kidney disease (CKD) and symptomatic coronary artery disease (CAD) are associated with cardiovascular risk factors. Some studies reported a hemodynamic coronary steal and consequent major adverse cardiac events (MACE) during hemodialysis in these patients [5,6,7,8,9,10], no reports definitely document the effects of the location (forearm vs upper arm) and type (arteriovenous fistula [AVF] vs prosthetic arteriovenous grafting [AVG]) of the VA on long-term clinical outcomes. The aims of the present study were to evaluate whether VA creation in the upper-extremity increases the risks of MACE and late death from any cause in patients with CABG with an in situ ITA graft, and to determine the clinical variables associated with MACE and late death in these patients
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
