(Circulation. 1995;91:46-53.)
© 1995 American Heart Association, Inc.
Articles |
Surgical Therapy for Coronary Artery Disease Among Patients With Combined Coronary Artery and Peripheral Vascular Disease
From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn (C.S.R., B.J.G.); Department of Clinical Cardiology, Massachusetts General Hospital, Boston (K.A.E.); Department of Biostatistics, University of Washington, Seattle (M.C.M.); Albany (NY) Medical College (E.D.F.); and Cardiac Diseases Branch, National Heart, Lung, and Blood Institute, Bethesda, Md (G.S.).
Background Among patients with combined coronary artery and peripheral vascular disease, long-term benefits of surgical therapy compared with medical therapy for coronary artery disease are unknown.
Methods and Results Using prospectively collected data from the
Coronary Artery Surgery Study registry, we performed a retrospective
cohort analysis of 1834 patients (mean age, 56 years; 20% women)
with both coronary artery and peripheral vascular disease and evaluated
their long-term outcomes. Of these patients, 986 received (nonrandomly)
coronary artery bypass graft surgery, and 848 were treated medically.
Perioperative mortality was 4.2% (2.9% in the absence of peripheral
vascular disease; P=.02). In a mean follow-up period of 10.4
years, 1100 deaths occurred (80% due to cardiovascular causes). For
the surgical group, 4-, 8-, 12-, and 16-year estimated probabilities of
survival were 88%, 72%, 55%, and 41%, respectively, and 73%, 57%,
44%, and 34%, respectively, for the medical group
(P<.0001). Multivariate analysis demonstrated that type
of therapy was independently associated with survival
(P=.0001; 
2=15.34). Subgroup
analysis suggested that benefits of surgical treatment on survival
were limited to patients with three-vessel coronary artery disease and
were inversely related to ejection fraction. Survival free of death or
myocardial infarction was also significantly better among the surgical
group. Type of therapy was significantly associated with occurrence of
late events (P=.01; 2=6.55). Subgroup
analysis again demonstrated that beneficial effects of surgery were
limited to patients with three-vessel coronary artery disease and were
inversely related to ejection fraction.
Conclusions Surgical treatment provides long-term benefit for certain subgroups of patients with combined coronary artery and peripheral arterial vascular disease.
Key Words: bypass • peripheral vascular disease • coronary disease • surgery
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