title: Impact of polyvascular disease on clinical outcomes in patients undergoing coronary revascularization: an observation from the CREDO-Kyoto Registry Cohort-2.
abstract: OBJECTIVE
  Patients with coronary artery disease (CAD) often have prior stroke or concomitant extra-cardiac vascular disease (EVD) such as cerebral, aortic, or peripheral vascular disease. However, clinical outcomes after coronary revascularization in patients with polyvascular disease have not been fully elucidated.
  
  
  METHODS
  Among 15,263 patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto registry Cohort-2 from January 2005 to December 2007, there were 1443 patients with prior stroke (stroke + CAD group), 974 patients with EVD (EVD + CAD group), 253 patients with both prior stroke and EVD (stroke/EVD/CAD group) and 12,593 patients with neither prior stroke nor EVD (CAD alone group [reference]).
  
  
  RESULTS
  The cumulative incidence of major adverse cardiovascular events (MACE: composite of cardiovascular death, myocardial infarction and stroke) through 3 years was significantly higher in patients with polyvascular disease compared with reference patients (19.9% in the stroke + CAD group, 18.5% in the EVD + CAD group, 20.1% in the stroke/EVD/CAD group, and 11.2% in the CAD alone group, P < 0.0001). After adjusting confounders, the presence of EVD and/or stroke was independently associated with higher risk for MACE compared with the reference group (adjusted HR [95%CI]: 1.34 [1.17-1.54], P < 0.0001 in the stroke + CAD group, 1.56 [1.32-1.84], P < 0.0001 in the EVD + CAD group, and 1.66 [1.24-2.23], P = 0.0007 in the stroke/EVD/CAD group). However, the presence of EVD and/or stroke was not associated with higher risk for myocardial infarction.
  
  
  CONCLUSIONS
  Clinical outcome after coronary revascularization was worse in patients with prior stroke and/or EVD, which was mainly driven by the increased risk for non-coronary cardiovascular events.
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University, Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Morikami
authors.forename: Masahiro
authors.initials: M
authors.lastname: Natsuaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Koh
authors.initials: K
authors.lastname: Ono
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
authors.forename: Masaki
authors.initials: M
authors.lastname: Aota
authors.forename: Yukikatsu
authors.initials: Y
authors.lastname: Okada
authors.forename: Masahiko
authors.initials: M
authors.lastname: Onoe
authors.forename: Michio
authors.initials: M
authors.lastname: Kawasuji
authors.forename: Takaaki
authors.initials: T
authors.lastname: Koshiji
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Junichiro
authors.initials: J
authors.lastname: Nishizawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome