THE EFFECT OF PERIPHERAL VASCULAR-DISEASE ON IN-HOSPITAL MORTALITY-RATES WITH CORONARY-ARTERY BYPASS-SURGERY

Purpose: The purpose of this study was to examine the effect of periph eral vascular disease (PVD) on in-hospital mortality rates after coron ary artery bypass grafting (CABG). Methods: We performed a regional co hort study of 3003 patients undergoing CABG between 1987 and 1989 at f ive tertiary care centers in Maine, New Hampshire, and Vermont. Data r eflecting patient characteristics, severity of heart disease, comorbid ity, and in-hospital mortality rates were collected prospectively; the presence of clinical and subclinical indicators of PVD was determined retrospectively. Results: Observed in-hospital mortality rates with C ABG were 2.4-fold higher in the 796 patients with indicators of PVD (7 .7%) than in the 2207 patients without PVD (3.2%) (crude odds ratio [O R] 2.42 [95% confidence interval (CI) 1.73-3.37]). After adjusting for their higher comorbidity scores, more advanced heart disease, and age , patients with PVD remained 73% more likely to die in hospital after CABG (adjusted OR 1.73 [CI 1.19-2.51]). The excess risk of in-hospital death associated with PVD was attributable largely to lower extremity occlusive disease (adjusted OR 2.03 [CI 1.34-3.07]). Subclinical lowe r extremity occlusive disease (asymptomatic absence of pedal pulses) h ad the same effect as clinically overt disease. Cerebrovascular diseas e had a small and statistically nonsignificant effect on CABG-related deaths (adjusted OR 1.13 [CI 0.73-1.74]). Excess mortality rates in pa tients with PVD were primarily due to increased risk of death from hea rt failure and dysrhythmias, but not to cerebrovascular accidents or p eripheral arterial complications. Conclusions: The presence of lower e xtremity arterial occlusive disease;is an important, independent predi ctor of in-hospital mortality rates for patients undergoing CABG. Cont rolled studies of the long-term effects of CABG in patients with PVD a re needed to determine the optimal role of myocardial revascularizatio n in this population.