CORONARY-BYPASS IN VASCULAR PATIENTS - A RELATIVELY HIGH-RISK PROCEDURE

A premise of cardiac risk stratification is that the added risk of cor onary artery bypass grafting (CABG) is offset by the improved safety o f subsequent vascular reconstruction (VR). We questioned if elective C ABG is patients with severe peripheral vascular disease (PVD) is a rel atively high-risk procedure. A cohort study of 680 elective CABG patie nts from January 1993 to December 1994 was performed using three mutua lly exclusive outcomes of complication-free survival, morbidity, and m ortality. Patient characteristic, operative, and outcome data were pro spectively collected. Retrospective review determined that 58 patients had either a standard indication for or a history of VR. Overall CABG mortality was 2.5%, with statistically similar but relatively higher rates for PVD as compared to non-PVD patients. In contrast, major morb idity occurred at rates 3.6-fold higher in PVD patients (39.7%) than i n disease-free patients (16.7%) after adjustment for the effects of pa tient and operative variables (odds ratio [OR] 3.67, 95% confidence in terval [CI] 1.93-6.99). CABG morbidity in the PVD patient was most lik ely in those patients with aortoiliac (OR 9.51, CI 3.20-28.27) and aor tic aneurysmal (OR 5.24, CI 1.28-21.41) disease types. CABG in PVD pat ients is associated with significant major morbidity. Such morbidity m ay preclude or alter the timing of subsequent VR.