COMPARISON OF CARDIAC MORBIDITY RATES BETWEEN AORTIC AND INFRAINGUINAL OPERATIONS - 2-YEAR FOLLOW-UP

Purpose: We have previously prospectively compared the differences in perioperative cardiac ischemic events in 140 patients undergoing major abdominal (n = 53) versus infrainguinal (n = 87) vascular operations. This study was designed to extend these observations by determining t he 2-year cardiac prognosis of patients at high risk undergoing abdomi nal aortic versus infrainguinal vascular operations. Methods: Data inc luded historical, clinical, and laboratory data collected during the i n-hospital period, and at 6 months, 1 year, and 2 years after surgery. This information was collected independently of the usual clinical ca re visits. Data were analyzed with Cox's proportional hazards model. R esults. There were 11 in-hospital deaths overall (five [9%] aortic; si x [7%]) infrainguinal). The remaining 129 patients (48 aortic; 81 infr ainguinal) were monitored for a mean of 628 days (median 726 days). Fi fteen patients (12%) had fatal myocardial infarctions, two (4%) of whi ch occurred in patients who underwent aortic procedures and 13 (16%) o f which occurred in patients who underwent infrainguinal operations. N onfatal myocardial infarctions befell one (2%) patient undergoing aort ic surgery and four (5%) patients undergoing infrainguinal surgery. On e (2%) patient undergoing aortic surgery and three (4%) patients under going infrainguinal surgery were admitted to the hospital with unstabl e angina during the follow-up period. In all, adverse cardiac outcomes occurred in 20 of 81 (25%) patients who had infrainguinal procedures compared with four of 48 (8%) patients who had aortic operations (p = 0.04). Multivariate analysis showed that a history of diabetes (p = 0. 001) and definite coronary artery disease (p = 0.01) are independently associated with adverse outcomes after both types of peripheral vascu lar operations. Conclusions: The incidence of long-term adverse cardia c outcomes in patients at high risk undergoing infrainguinal operation s is substantially greater than in those undergoing aortic operations, mostly because of a greater prevalence of diabetes and definite coron ary artery disease in the former group.