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Impact of extracardiac vascular disease on vein graft failure and outcomes after coronary artery bypass surgery.

Publication ,  Journal Article
Harskamp, RE; Alexander, JH; Schulte, PJ; Jones, WS; Williams, JB; Mack, MJ; Peterson, ED; Gibson, CM; Califf, RM; Kouchoukos, NT; Ferguson, TB ...
Published in: Ann Thorac Surg
March 2014

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.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

March 2014

Volume

97

Issue

3

Start / End Page

824 / 830

Location

Netherlands

Related Subject Headings

  • Veins
  • Treatment Outcome
  • Treatment Failure
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Peripheral Vascular Diseases
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Harskamp, R. E., Alexander, J. H., Schulte, P. J., Jones, W. S., Williams, J. B., Mack, M. J., … Lopes, R. D. (2014). Impact of extracardiac vascular disease on vein graft failure and outcomes after coronary artery bypass surgery. Ann Thorac Surg, 97(3), 824–830. https://doi.org/10.1016/j.athoracsur.2013.09.099
Harskamp, Ralf E., John H. Alexander, Phillip J. Schulte, W Schuyler Jones, Judson B. Williams, Michael J. Mack, Eric D. Peterson, et al. “Impact of extracardiac vascular disease on vein graft failure and outcomes after coronary artery bypass surgery.Ann Thorac Surg 97, no. 3 (March 2014): 824–30. https://doi.org/10.1016/j.athoracsur.2013.09.099.
Harskamp RE, Alexander JH, Schulte PJ, Jones WS, Williams JB, Mack MJ, et al. Impact of extracardiac vascular disease on vein graft failure and outcomes after coronary artery bypass surgery. Ann Thorac Surg. 2014 Mar;97(3):824–30.
Harskamp, Ralf E., et al. “Impact of extracardiac vascular disease on vein graft failure and outcomes after coronary artery bypass surgery.Ann Thorac Surg, vol. 97, no. 3, Mar. 2014, pp. 824–30. Pubmed, doi:10.1016/j.athoracsur.2013.09.099.
Harskamp RE, Alexander JH, Schulte PJ, Jones WS, Williams JB, Mack MJ, Peterson ED, Gibson CM, Califf RM, Kouchoukos NT, Ferguson TB, de Winter RJ, Lopes RD. Impact of extracardiac vascular disease on vein graft failure and outcomes after coronary artery bypass surgery. Ann Thorac Surg. 2014 Mar;97(3):824–830.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

March 2014

Volume

97

Issue

3

Start / End Page

824 / 830

Location

Netherlands

Related Subject Headings

  • Veins
  • Treatment Outcome
  • Treatment Failure
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Peripheral Vascular Diseases
  • Middle Aged
  • Male
  • Humans