ABSTRACT
Introduction:
The presence of non-
coronary atherosclerosis (NCA) in
patients with
coronary artery disease is associated with a poor
prognosis. We have studied whether NCA is also a predictor of poorer outcomes in
patients undergoing
coronary artery bypass grafting (CABG). Materials and
methods:
This is an
observational study involving 567 consecutive
patients who underwent CABG. Variables and
prognosis were analysed based on the presence or absence of NCA, defined as previous
stroke,
transient ischaemic attack (TIA), or
peripheral artery disease (PAD) [
lower extremity artery disease (
LEAD), carotid
disease, previous
lower limb vascular surgery, or
abdominal aortic aneurysm (AAA)]. The primary outcome was a combination of TIA/
stroke, acute myocardial infarction, new revascularization
procedure, or
death. The
secondary outcome added the need for
LEAD revascularization or AAA
surgery.
Results:
One-hundred thirty-eight
patients (24%) had NCA. Among them, traditional
cardiovascular risk factors and older age were more frequently present. At
multivariate analysis, NCA [
hazard ratio (HR) = 1.84, 95%
confidence interval (CI) 1.27-2.69], age (HR = 1.35, 95% CI 1.09-1.67, p = 0.004), and
diabetes mellitus (HR = 1.50, 95% CI 1.05-2.15, p = 0.025), were positively associated with the development of the primary outcome, while estimated
glomerular filtration rate (HR = 0.86, 95% CI 0.80-0.93, p = 0.001) and use of left
internal mammary artery (HR = 0.36, 95% CI 0.15-0.82, p = 0.035), were inversely associated with this outcome. NCA was also an independent predictor of the
secondary outcome.
Mortality was also higher in NCA
patients (27.5% vs. 9%, p < 0.001).
Conclusions:
Among
patients undergoing CABG, the presence of NCA doubled the
risk of developing cardiovascular events, and it was associated with higher
mortality.