Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population.
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.
van Straten
Albert H M
AH
Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Firanescu
Cristina
C
Soliman Hamad
Mohamed A
MA
Tan
M Erwin S H
ME
ter Woorst
Joost F J
JF
Martens
Elisabeth J
EJ
van Zundert
André A J
AA
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery; D009426:Netherlands; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate