Peripheral Artery Disease: More Than A Mere Bystander
Vincent Chauvette1, Louis-Mathieu Stevens2, Raymond Cartier1.
1Montreal Heart Institute, Montreal, QC, Canada, 2Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada.
OBJECTIVE: Peripheral artery disease (PAD) is an increasingly common comorbidity in patients requiring coronary revascularisation. It is a known risk factor of complications following coronary artery bypass grafting (CABG). We sought to investigate the impact of this comorbidity on long-term survival in a contemporary cohort of patients who underwent off-pump CABG (OPCABG).
METHODS: Between 1998 and 2008, 1500 patients underwent an OPCABG in our institution. Among them, 293 had PAD (by the STS definition). Their preoperative characteristics and postoperative outcomes were compared with the rest of the cohort. The survival of the cohort was compared with that of the sex- and age-matched population. The median follow-up is 5.0 years [3.4-9.5 years].
RESULTS: Patients with PAD were slightly older (67 ± 10 vs 64 ± 10 years, p<0.01), had more hypertension (71% vs 60%, p<0.01), heart failure (16% vs 6%, p<0.01) and had less diabetes (61% vs 71%, p<0.01). The number of bypasses were similar between patients with PAD and those without (3.1 ± 0.8 vs 3.1 ± 0.9, p=0.42). Post-operative complications were more common in patients with PAD: atrial fibrillation (31% vs 24%, p=0.02), peri-operative mortality (3.8% vs 1.2%, p<0.01), delirium (18% vs 10%, p<0.01), pulmonary infection (12% vs 7%, p<0.01), and higher rates of delta CKMB >100 (6% vs 2%, p<0.01). At 15 years, the survival was significantly different between patients with preoperative PAD and those without (33 ± 5.1% vs 56.4 ± 2.7%, p<0.01). The patients with PAD showed an early significant difference with the survival of the sex- and age-matched population whereas the difference appeared later (>10 years) in patients without PAD (Figure 1).
CONCLUSIONS: In patients undergoing OPCABG, PAD is a marker of systemic disease associated with poor early and late outcomes. The survival of patients with PAD is significantly lower than that of the sex- and age-matched population. These findings may help clinicians in deciding treatment options for patients with PAD and certainly reinforces the need to insure optimal secondary prevention in this patient population.
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