Prognostic effect of peripheral vascular disease in patients undergoing coronary artery bypass graft surgery

Abstract Introduction Atherosclerosis vascular disease is one of the main causes of morbidity and mortality in the world. We aimed to evaluate the prognostic impact of a history of peripheral vascular disease in patients undergoing coronary artery bypass graft surgery (CABG). Methods Single-center, observational and retrospective study including all patients undergoing CABG in our center between 2010 and 2018. Electronic health records were used to record clinical characteristics to identify patients with a history of peripheral vascular disease. This one was defined as having a history of stroke or transient ischemic attack (TIA), intermittent claudication, or previous percutaneous or surgical arterial procedure. Patients were followed until December 2019. The primary endpoint (PE) was the composite of stroke, TIA, myocardial infarction, new coronary revascularization, inferior limb vascular or aortic aneurysm intervention, and death. Results We included 567 patients, 138 (24.3%) with a history of peripheral vascular disease (stroke/TIA 34.1%; carotid surgery 6.5%; inferior limb surgery 12.3%; abdominal aortic aneurysm surgery 8.7% and intermittent claudication 38.4%). Baseline characteristics of the overall cohort and different subgroups (with and without peripheral vascular disease) can be seen in the table. The group with peripheral vascular disease had a worse clinical profile. They were significantly older, more frequently males, and smokers. They also had a higher prevalence of hypertension, diabetes, dyslipidemia, chronic kidney disease, and neoplasms. In addition, the preoperative status was less favorable, left ventricular ejection fraction and hemoglobin were lower, and renal function was worse than the group without peripheral vascular disease. The median follow-up was 4.2 years. During the study period, 55 patients (40%) with peripheral vascular disease and 80 patients (18.6%) without peripheral vascular disease reached the PE. After multivariate Cox modeling, variables independently related to PE were diabetes (HR=1.65 (1.17–2.33); p=0.004), creatinine levels (HR= 1.32 (1.19–1.47); p≤0.001) and peripheral vascular disease (HR= 2.28 (1.60–3.25); p≤0.001) (figure, panel A). Kaplan-Meier survival curves of PE according to the presence of peripheral vascular disease prior to CABG are shown in panel B of the figure. Conclusion According to our results, patients with peripheral vascular disease have approximately double the risk of suffering a majo