Comparison of cardiac morbidity rates between aortic and infrainguinal operations: two-year follow-up. Study of Perioperative Ischemia Research Group.
OBJECTIVE
We have previously prospectively compared the differences in perioperative cardiac ischemic events in 140 patients undergoing major abdominal (n = 53) versus infrainguinal (n = 87) vascular operations. This study was designed to extend these observations by determining the 2-year cardiac prognosis of patients at high risk undergoing abdominal aortic versus infrainguinal vascular operations.


METHODS
Data included historical, clinical, and laboratory data collected during the in-hospital period, and at 6 months, 1 year, and 2 years after surgery. This information was collected independently of the usual clinical care visits. Data were analyzed with Cox's proportional hazards model.


RESULTS
There were 11 in-hospital deaths overall (five [9%] aortic; six [7%]) infrainguinal). 628 days (median 726 days). Fifteen patients (12%) had fatal myocardial infarctions, two (4%) of which occurred in patients who underwent aortic procedures and 13 (16%) of which occurred in patients who underwent infrainguinal operations. Nonfatal myocardial infarctions befell one (2%) patient undergoing aortic surgery and four (5%) patients undergoing infrainguinal surgery. One (2%) patient undergoing aortic surgery and three (4%) patients undergoing infrainguinal surgery were admitted to the hospital with unstable angina during the follow-up period. In all, adverse cardiac outcomes occurred in 20 of 81 (25%) patients who had infrainguinal procedures compared with four of 48 (8%) patients who had aortic operations (p = 0.04). Multivariate analysis showed that a history of diabetes (p = 0.001) and definite coronary artery disease (p = 0.01) are independently associated with adverse outcomes after both types of peripheral vascular operations.


CONCLUSIONS
The incidence of long-term adverse cardiac outcomes in patients at high risk undergoing infrainguinal operations is substantially greater than in those undergoing aortic operations, mostly because of a greater prevalence of diabetes, and definite coronary artery disease in the former group.
Krupski
W C
WC
Section of Vascular Surgery, University of Colorado School of Medicine, Denver 80262.
Layug
E L
EL
Reilly
L M
LM
Rapp
J H
JH
Mangano
D T
DT
D000368:Aged; D000789:Angina, Unstable / Q000209:etiology; D001018:Aortic Diseases / Q000601:surgery*; D002423:Cause of Death; D015716:Electrocardiography, Ambulatory; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D005544:Forecasting; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D017202:Myocardial Ischemia / Q000209:etiology*; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000209:etiology; D016896:Treatment Outcome