Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

Ann Thorac Surg. 2010 Feb;89(2):414-20. doi: 10.1016/j.athoracsur.2009.11.036.

Abstract

Background: The European system for cardiac operative risk evaluation, the most popular European scoring system in cardiac surgery, uses the extracardiac arteriopathy as a risk factor for early mortality. We studied the effect of peripheral vascular disease (PVD) on early and late mortality in a large group of patients undergoing isolated coronary artery bypass surgery (CABG) surgery.

Methods: During a ten-year period (January 1998 through December 2007) 10,626 patients underwent isolated CABG in our hospital. The primary endpoints of this study were early and late all-cause mortality. For each year of the study period, general population cohorts were matched with the patient groups for age and gender (expected survival).

Results: Out of 10,504 patients included in the analysis, 1,222 (11.63%) patients had PVD. The PVD was identified as an independent risk factor for late mortality (death at any time after hospital discharge) (hazard ratio of 1.67 [1.43 to 1.95], p < 0.0001), but not for early mortality (death within 30 days or before discharge) (hazard ratio of 1.06 [0.70 to 1.60], p = 0.776). Patients without PVD had a better survival than patients with PVD (log-rank p < 0.0001) and even a better survival compared to the normal Dutch population survival (p value < 0.002). The PVD patients had a worse than expected survival (log-rank p < 0.0001).

Conclusions: Peripheral vascular disease is an independent risk factor only for late mortality but not for early mortality. Compared with age-matched and sex-matched cohorts from the general Dutch population, the ten-year survival of patients with peripheral vascular disease was worse; whereas the survival of patients with no peripheral vascular disease was better.

MeSH terms

  • Aged
  • Arterial Occlusive Diseases / mortality*
  • Cause of Death
  • Cohort Studies
  • Comorbidity
  • Coronary Artery Bypass*
  • Coronary Disease / mortality*
  • Coronary Disease / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality
  • Myocardial Infarction / surgery
  • Netherlands
  • Postoperative Complications / mortality*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Survival Rate