Impact of polyvascular disease on clinical outcomes in patients undergoing coronary revascularization: An observation from the CREDO-Kyoto Registry Cohort-2

Morikami, Yasuhiro; Natsuaki, Masahiro; Morimoto, Takeshi; Ono, Koh; Nakagawa, Yoshihisa; Furukawa, Yutaka; Sakata, Ryuzo; Aota, Masaki; Okada, Yukikatsu; Onoe, Masahiko; Kawasuji, Michio; Koshiji, Takaaki; Nakajima, Hiroyuki; Nishizawa, Junichiro; Yamanaka, Kazuhiro; Yamamoto, Hiroyuki; Kimura, Takeshi

doi:10.1016/j.atherosclerosis.2013.04.005

Cited by 27 publications

(33 citation statements)

References 22 publications

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“…These patients were not included in our PVD cohort, all of whom had PVD involving the aorta, renal arteries or extremities. There is some evidence that cerebrovascular disease may be a lesser risk factor for adverse outcomes after PCI than peripheral arterial disease 11,12 hence their inclusion in the PVD cohort may have reduced the apparent overall increased risk among their PVD group. The increased rate of adverse outcomes observed in our PVD group may be related to their higher rate of periprocedural bleeding events (3.8% vs. 2.4%, p = 0.004).…”

Section: Discussionmentioning

confidence: 99%

Outcomes in patients with peripheral vascular disease following percutaneous coronary intervention

Ramzy

Andrianopoulos

Roberts

et al. 2019

Cathet Cardio Intervent

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Objectives To evaluate the clinical characteristics and outcomes of patients with peripheral vascular disease (PVD) undergoing percutaneous coronary intervention (PCI) in a contemporary setting, and to determine whether use of drug‐eluting stents (DESs) improves outcomes. Background PVD was an independent risk factor for adverse outcomes following PCI in the bare‐metal stent (BMS) era. It is not known whether outcomes in these patients have improved with advances in interventional techniques and stent technology, as they have for the general population. Methods Eighteen thousand three hundred and eighty patients undergoing PCI from an Australian registry between 2005 and 2013 were studied. Clinical and procedural data, 30‐day and 12‐month outcomes were compared in those with and without a reported history of PVD. Outcomes were also compared between patients with PVD who received DES and those who received BMS. Long‐term mortality was compared using Australian National Death Index (NDI) linkage. Results Patients with PVD (n = 1,251, 6.8%) were older and had more prevalent diabetes, hypertension, cerebrovascular disease, heart failure, renal impairment, ostial lesions, left main, and multi‐vessel disease (p < 0.001). Patients with PVD had significantly higher rates of major adverse cardiovascular events (MACEs) compared with those without PVD, in‐hospital (5.7% vs. 4.1%, p < 0.008), at 30‐days (8.6% vs. 5.8%, p < 0.001) and at 12‐months (24.6% vs. 13.2%, p < 0.001). At 4.9 ± 2.6 years follow‐up, there was significantly greater mortality in the PVD group. PVD patients who received DES experienced significantly less MACE than PVD patients treated with BMS at 30‐days (4.8 vs. 10.1%, p < 0.001) and 12‐months (19.4 vs. 26.4%, p < 0.005). Conclusions PVD is an independent predictor of adverse outcomes in patients undergoing PCI. PVD patient who received DES had improved outcomes compared with those receiving BMS.

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Section: Discussionmentioning

confidence: 99%

Outcomes in patients with peripheral vascular disease following percutaneous coronary intervention

Ramzy

Andrianopoulos

Roberts

et al. 2019

Cathet Cardio Intervent

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“…Moreover, patients with subclinical ECADs were more often on ASA, beta blockers, ACE-I/ARB, and statins at admission than those without ECAD. However, medication at admission was not accounted for in most previous studies [4,5,7,12,16,25]. Participants with clinical ECAD had higher frequency of statin treatment at admission.…”

Section: Discussionmentioning

confidence: 95%

“…Several previous studies have shown that patients with CAD and concomitant clinical ECADs are at increased risk of recurrent adverse cardiovascular events and mortality [4,5,7,9,10,18]. The frequency of ECAD among patients with AMI is substantial and vary between 13 and 43%, depending on study population and definition of ECAD [4,7,8,12].…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction

et al. 2017

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“…Accordingly, triple-vessel and left main coronary artery disease and peripheral artery disease were most frequently found in the ECAS + ICAS group. Polyvascular disease and high systemic atherosclerosis burden were previously shown to be associated with increased risk of adverse cardiovascular outcomes [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Cerebral Atherosclerosis According to Location on Prognosis after Coronary Artery Bypass Grafting

et al. 2018

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Background: In the previous prospective observational study, we found that cerebral atherosclerosis is an independent predictor of acute stroke after coronary artery bypass grafting (CABG). However, it is unknown whether intracranial cerebral atherosclerosis (ICAS) is important as much as extracranial cerebral atherosclerosis (ECAS) in estimating the risk of post-CABG adverse events. Extending the previous study, we aimed to investigate the immediate and long-term prognostic value of the location of cerebral atherosclerosis in CABG patients. Methods: This follow-up study of previously reported prospective cohort included 1,367 consecutive patients who received CABG between 2004 and 2007. All patients underwent preoperative magnetic resonance angiography (MRA) to assess intracranial and ECAS, both defined by significant steno-occlusion (≥50%). Participants were classified into 4 groups according to the location of cerebral atherosclerosis: no cerebral atherosclerosis, ECAS only, ICAS only, and ECAS + ICAS. Post-CABG stroke within 14 days (immediate outcome) and mortality (long-term outcome) following CABG were compared between the groups. Survival data for all participants through June 2016 were obtained from the Korean National Registry of Vital Statistics. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of post-CABG stroke and mortality; patients lacking cerebral atherosclerosis were defined as the reference group. Results: The median follow-up duration after CABG was 9.2 years (interquartile range 8.4–10.2 years). Of the participants, 278 (20.3%) patients had ICAS only, while 269 (19.7%) and 347 (25.4%) showed ECAS only and ECAS + ICAS, respectively, in their preoperative MRA. Having ICAS only (HR 5.07; 95% CI 1.37–18.75; p = 0.015) and having ECAS + ICAS (HR 8.43; 95% CI, 2.48–28.61; p = 0.001) independently predicted the immediate stroke, whereas being with ECAS only did not (HR 1.71; 95% CI 0.35–8.50; p = 0.509). Conversely, ICAS-only status was not independently associated with long-term mortality (HR 1.22; 95% CI 0.90–1.65; p = 0.207), whereas ECAS-only status (HR 1.42; 95% CI 1.05–1.90; p = 0.021) and ECAS + ICAS status (HR 1.58; 95% CI 1.20–2.07; p = 0.001) showed independent associations. Conclusions: Over 10 years of follow-up, cerebral atherosclerosis significantly associated with the development of adverse outcomes after CABG. The prognostic value of ICAS might be different from that of ECAS; immediate post-CABG stroke was more closely associated with ICAS, whereas there was a closer association between long-term post-CABG mortality and ECAS.

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Impact of polyvascular disease on clinical outcomes in patients undergoing coronary revascularization: An observation from the CREDO-Kyoto Registry Cohort-2

Abstract: Clinical outcome after coronary revascularization was worse in patients with prior stroke and/or EVD, which was mainly driven by the increased risk for non-coronary cardiovascular events.

Cited by 27 publications

References 22 publications

Outcomes in patients with peripheral vascular disease following percutaneous coronary intervention

Outcomes in patients with peripheral vascular disease following percutaneous coronary intervention

Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction

The Impact of Cerebral Atherosclerosis According to Location on Prognosis after Coronary Artery Bypass Grafting

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