March 1996

The Effect of Peripheral Vascular Disease on Long-term Mortality After Coronary Artery Bypass Surgery

Author Affiliations

for the Northern New England Cardiovascular Disease Study Group
From the Departments of Surgery (Drs Birkmeyer and McDaniel and Ms O'Connor), Medicine (Dr O'Connor and Ms Quinton), and Community and Family Medicine (Drs Birkmeyer and O'Connor) and Center for the Evaluative Clinical Sciences (Drs Birkmeyer and O'Connor), Dartmouth Medical School, Hanover, NH (Mss Quinton and O'Connor); Veterans Affairs Hospital, White River Junction, Vt (Drs Birkmeyer and McDaniel); and Departments of Surgery, Medical Center Hospital of Vermont, Burlington (Drs Leavitt and Ricci), Catholic Medical Center, Manchester, NH (Dr Charlesworth), and Eastern Maine Medical Center, Bangor (Dr Hernandez).

Arch Surg. 1996;131(3):316-321. doi:10.1001/archsurg.1996.01430150094018

Objective:  To examine the effect of peripheral vascular disease (PVD) on long-term mortality after successful myocardial revascularization.

Methods:  We performed a regional cohort study of 2871 consecutive patients discharged alive after coronary artery bypass graft surgery at five tertiary care centers in Maine, New Hampshire, and Vermont between 1987 and 1989. Data reflecting patient characteristics, heart disease severity, and comorbidity were collected prospectively; the presence of clinical and subclinical indicators of PVD was determined by medical record review; and vital status was determined using the National Death Index (mean follow-up, 4.4 years).

Results:  Five-year mortality following coronary artery bypass graft surgery was substantially higher in the 755 patients with indicators of PVD (20%; 95% confidence interval [CI], 17% to 23%) than in the 2116 patients without PVD (8%; 95% CI, 7 to 9; P<.001). The crude hazard ratio of long-term mortality associated with PVD was 2.77 (95% CI, 2.19 to 3.50; P<.001). After adjusting for their higher comorbidity scores, more advanced cardiac disease, and age, mortality rates in patients with PVD remained twice as high as those in patients without PVD (adjusted hazard ratio, 2.01; 95% CI, 1.57 to 2.58; P<.001). Long-term mortality was increased in patients with any of the indicators of PVD. Patients with multilevel PVD had especially high late mortality rates (adjusted hazard ratio, 2.46; 95% CI, 1.64 to 3.68; P<.001).

Conclusions:  Even after successful myocardial revascularization, patients with PVD remain at substantially increased risk for long-term mortality. The presence of clinical or subclinical PVD is important when predicting both short- and long-term outcomes in patients considering coronary artery bypass graft surgery.(Arch Surg. 1996;131:316-321)