Prevalence of peripheral arterial disease and prior stroke in octogenarians with symptomatic severe aortic stenosis or severe coronary artery disease: influence in management and outcome.
OBJECTIVE
Severe aortic stenosis (SAS) and severe coronary artery disease (SCAD) are the most frequent reasons to perform cardiac surgery in octogenarians. Non-coronary vascular disease is frequently present in these patients.


METHODS
We assessed the prevalence and impact of previous stroke (PS) and peripheral arterial disease (PAD) on the management and outcome of 130 consecutive symptomatic patients (80 years old with SAS or SCAD.


RESULTS
Mean age was 82.8+/-3.1 years. PS was present in 24 patients (18.5%) and PAD in 15 (11.5%). We found a non-significant trend to a higher prevalence of PAD in patients with SCAD than in patients with SAS (14.5% vs 6.4%, P=0.13), while no relevant differences were seen for PS prevalence (19.3% vs 17%, P=0.75). Patients with PS tended to be operated less frequently than patients without PS (20.8% vs 37.7%, P=0.08), while no relevant differences were seen for patients with and without PAD (26.7% vs 35.7%, P=0.5). Thirty-nine patients (30%) died during follow-up, mean of 1.1(0.7 years (median 1 years; 100% complete). There was a trend to a worse prognosis in patients with PAD (adjusted hazard ratio [HR] 2.2; 95% confidence interval [CI] 0.96-4.8; P=0.06), while PS showed no independent influence on survival (adjusted HR 1.3, 95% CI 0.6-2.8, P=0.53).


CONCLUSIONS
PS and PAD are frequently present in octogenarians with SAS or SCAD. Patients with PS show a similar long-term mortality, but tend to be operated less frequently. On the other hand, PAD did not influence the decision of surgical treatment, but is associated with a lower survival rate.
Martinez-Selles
M
M
Department of Cardiology, Gregorio Marañón University Hospital, Madrid, Spain. mmselles@secardiologia.es
Barrio
J M
JM
Hortal
J
J
Ruiz
M
M
Bueno
H
H
D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D006348:Cardiac Surgical Procedures; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome