Increased incidence of periprocedural complications among patients with peripheral vascular disease undergoing myocardial revascularization in the bypass angioplasty revascularization investigation

Background-Risks of coronary artery bypass graft surgery (CABG) or percutan eous transluminal coronary angioplasty (PTCA) may be different in the prese nce of peripheral vascular disease (PVD), Methods and Results-We analyzed outcomes of 550 patients with PVD enrolled in the Bypass Angioplasty Revascularization Investigation randomized trial and registry. Compared with 1770 patients without PVD, those with PVD were older and had a greater prevalence of medical comorbid conditions. No signi ficant differences in coronary anatomy or PTCA success rates were found. Th e risk of any major complication (death, myocardial infarction, stroke, com a, or emergency revascularization) after PTCA was significantly higher amon g patients with PVD (11.7% versus 7.8%, P=0.027). In multivariate analysis, this represented a 50% increase in the odds of having any major complicati on (multivariate odds ratio, 1.5; P=0.032). Among patients undergoing CABG, the risk of major complications was found to be markedly higher for patien ts with PVD (12%) than those without (6.1%, P=0.003) even after controlling for baseline differences (multivariate odds ratio, 1.8; P=0.018). Major di fferences between the PTCA and CABG groups were related primarily to a high er risk of neurological complications in PVD patients who had CABG (multiva riate odds ratio, 2.8; P<0.001). Conclusions-We conclude that patients with PVD are at high risk for peripro cedural complications after myocardial revascularization, in particular neu rological events.