Ralf E Harskamp1, John H Alexander2, Phillip J Schulte2, W Schuyler Jones3, Judson B Williams3, Michael J Mack4, Eric D Peterson2, C Michael Gibson5, Robert M Califf6, Nicholas T Kouchoukos7, T Bruce Ferguson8, Robbert J de Winter9, Renato D Lopes10. 1. Duke Clinical Research Institute, Durham, North Carolina; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 2. Duke Clinical Research Institute, Durham, North Carolina. 3. Duke University Medical Center, Durham, North Carolina. 4. Cardiopulmonary Research Science and Technology Institute, Dallas, Texas. 5. PERFUSE Angiographic Laboratory, Boston, Massachusetts. 6. Duke Translational Medicine Institute, Durham, North Carolina. 7. Missouri Baptist Medical Center, St. Louis, Missouri. 8. East Carolina University, Greenville, North Carolina. 9. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 10. Duke Clinical Research Institute, Durham, North Carolina. Electronic address: renato.lopes@duke.edu.
Abstract
BACKGROUND: While extracardiac vascular disease (ECVD), defined as a history of peripheral vascular disease (PVD) or cerebrovascular disease (CBVD), is common in patients undergoing coronary artery bypass graft (CABG) surgery, there are limited data available on the association between ECVD, vein graft failure (VGF), and clinical outcomes. METHODS: Using data from the Project of Ex-vivo Vein Graft Engineering via Transfection IV (PREVENTIV) trial (n = 3,014), 1-year angiographic follow-up and 5-year clinical outcomes (death, myocardial infarction, and revascularization) were determined in patients with and without ECVD. Logistic regression was used to assess risk of VGF. Generalized estimating equations methods were used to account for correlations in a graft-level analysis. Kaplan-Meier estimates and Cox hazards regression were used to compare clinical outcomes. We similarly explored the association of the individual components CBVD and PVD with both VGF and clinical outcomes in an additive model. RESULTS: Patients with ECVD (n = 634, 21%) were older, more commonly female, and had more comorbidities, lower use of internal thoracic artery grafting, and overall worse graft quality than patients without ECVD. VGF rates tended to be higher (patient-level: odds ratio [OR]: 1.23, 95% confidence interval [CI] 0.96 to 1.58, p = 0.099; graft-level: OR: 1.23, 95% CI: 1.00 to 1.53, p = 0.053) in patients with ECVD. VGF rates were significantly higher among CBVD patients (OR: 1.42, 95% CI: 1.03 to 1.97, p = 0.035; graft-level: OR: 1.40, 95% CI: 1.06 to 1.85, p = 0.019). Patients with ECVD had a higher risk of death, myocardial infarction, or revascularization 5 years after CABG surgery (hazard ratio [HR]: 2.96, 95% CI: 2.02 to 4.35, p < 0.001). This relationship was driven by the subset of patients with PVD (HR = 3.32, 95% CI: 2.16 to 5.09, p < 0.001) and not by those with CBVD (HR = 1.10, 95% CI: 0.88 to 1.37, p = 0.40). CONCLUSIONS: ECVD is common among patients undergoing CABG surgery and is associated with similar short-term but increasingly worse long-term clinical outcomes. This higher risk may be partly, but not exclusively, due to higher rates of VGF among these patients.
BACKGROUND: While extracardiac vascular disease (ECVD), defined as a history of peripheral vascular disease (PVD) or cerebrovascular disease (CBVD), is common in patients undergoing coronary artery bypass graft (CABG) surgery, there are limited data available on the association between ECVD, vein graft failure (VGF), and clinical outcomes. METHODS: Using data from the Project of Ex-vivo Vein Graft Engineering via Transfection IV (PREVENTIV) trial (n = 3,014), 1-year angiographic follow-up and 5-year clinical outcomes (death, myocardial infarction, and revascularization) were determined in patients with and without ECVD. Logistic regression was used to assess risk of VGF. Generalized estimating equations methods were used to account for correlations in a graft-level analysis. Kaplan-Meier estimates and Cox hazards regression were used to compare clinical outcomes. We similarly explored the association of the individual components CBVD and PVD with both VGF and clinical outcomes in an additive model. RESULTS:Patients with ECVD (n = 634, 21%) were older, more commonly female, and had more comorbidities, lower use of internal thoracic artery grafting, and overall worse graft quality than patients without ECVD. VGF rates tended to be higher (patient-level: odds ratio [OR]: 1.23, 95% confidence interval [CI] 0.96 to 1.58, p = 0.099; graft-level: OR: 1.23, 95% CI: 1.00 to 1.53, p = 0.053) in patients with ECVD. VGF rates were significantly higher among CBVD patients (OR: 1.42, 95% CI: 1.03 to 1.97, p = 0.035; graft-level: OR: 1.40, 95% CI: 1.06 to 1.85, p = 0.019). Patients with ECVD had a higher risk of death, myocardial infarction, or revascularization 5 years after CABG surgery (hazard ratio [HR]: 2.96, 95% CI: 2.02 to 4.35, p < 0.001). This relationship was driven by the subset of patients with PVD (HR = 3.32, 95% CI: 2.16 to 5.09, p < 0.001) and not by those with CBVD (HR = 1.10, 95% CI: 0.88 to 1.37, p = 0.40). CONCLUSIONS: ECVD is common among patients undergoing CABG surgery and is associated with similar short-term but increasingly worse long-term clinical outcomes. This higher risk may be partly, but not exclusively, due to higher rates of VGF among these patients.
Authors: John H Alexander; T Bruce Ferguson; Diane M Joseph; Michael J Mack; Randall K Wolf; C Michael Gibson; Daniel Gennevois; Todd J Lorenz; Robert A Harrington; Eric D Peterson; Kerry L Lee; Robert M Califf; Nicholas T Kouchoukos Journal: Am Heart J Date: 2005-10 Impact factor: 4.749
Authors: K Sutton-Tyrrell; C Rihal; M A Sellers; K Burek; J Trudel; G Roubin; M M Brooks; M Grogan; G Sopko; N Keller; R Jandová Journal: Am J Cardiol Date: 1998-02-15 Impact factor: 2.778
Authors: G W Roach; M Kanchuger; C M Mangano; M Newman; N Nussmeier; R Wolman; A Aggarwal; K Marschall; S H Graham; C Ley Journal: N Engl J Med Date: 1996-12-19 Impact factor: 91.245
Authors: R S D'Agostino; L G Svensson; D J Neumann; H H Balkhy; W A Williamson; D M Shahian Journal: Ann Thorac Surg Date: 1996-12 Impact factor: 4.330
Authors: Daniel J O'Rourke; Hebe B Quinton; Winthrop Piper; Felix Hernandez; Jeremy Morton; Bruce Hettleman; Michael Hearne; William Nugent; Gerald T O'Connor; David J Malenka Journal: Ann Thorac Surg Date: 2004-08 Impact factor: 4.330
Authors: Renato D Lopes; Judson B Williams; Rajendra H Mehta; Eric M Reyes; Gail E Hafley; Keith B Allen; Michael J Mack; Eric D Peterson; Robert A Harrington; C Michael Gibson; Robert M Califf; Nicholas T Kouchoukos; T Bruce Ferguson; Todd J Lorenz; John H Alexander Journal: Am Heart J Date: 2012-09 Impact factor: 4.749