Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease

C. S. Rihal, K. A. Eagle, M. C. Mickel, E. D. Foster, G. Sopko, B. J. Gersh

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

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; χ2=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; χ2=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.

Original languageEnglish (US)
Pages (from-to)46-53
Number of pages8
JournalCirculation
Volume91
Issue number1
StatePublished - 1995
Externally publishedYes

Fingerprint

Peripheral Vascular Diseases
Coronary Artery Disease
Coronary Vessels
Survival
Therapeutics
Peripheral Arterial Disease
Coronary Artery Bypass
Registries
Cohort Studies
Multivariate Analysis
Myocardial Infarction
Transplants
Mortality

Keywords

  • bypass
  • coronary disease
  • peripheral vascular disease
  • surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Rihal, C. S., Eagle, K. A., Mickel, M. C., Foster, E. D., Sopko, G., & Gersh, B. J. (1995). Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease. Circulation, 91(1), 46-53.

Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease. / Rihal, C. S.; Eagle, K. A.; Mickel, M. C.; Foster, E. D.; Sopko, G.; Gersh, B. J.

In: Circulation, Vol. 91, No. 1, 1995, p. 46-53.

Research output: Contribution to journalArticle

Rihal, CS, Eagle, KA, Mickel, MC, Foster, ED, Sopko, G & Gersh, BJ 1995, 'Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease', Circulation, vol. 91, no. 1, pp. 46-53.
Rihal, C. S. ; Eagle, K. A. ; Mickel, M. C. ; Foster, E. D. ; Sopko, G. ; Gersh, B. J. / Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease. In: Circulation. 1995 ; Vol. 91, No. 1. pp. 46-53.
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AU - Gersh, B. J.

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