Late results of coronary bypass in patients with peripheral vascular disease

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Coronary angiography was performed in a series of 1000 patients (mean age 64 years) under consideration for elective peripheral vascular reconstruction at the Cleveland Clinic. Of the 251 patients found to have severe, correctable coronary artery disease (CAD), 216 underwent myocardial revascularization as a preliminary procedure. The operative mortality for coronary bypass was 5.5%, but only three early deaths (1.5%) occurred among 200 patients in this subset who subsequently had peripheral vascular operations. In comparison, vascular procedures were undertaken with conventional precautions in 16 of the 35 patients with severe, correctable CAD who declined myocardial revascularization. Two (12%) of these patients had fatal complications (p = 0.045). Complete late information was available for over 98% of the study group during follow-up intervals of 3–7 years (mean 4.6 years). Including the operative mortality of coronary bypass, cardiac deaths have been reported in 12% of the 216 patients who received myocardial revascularization, a figure surpassed only by those having normal coronary arteries (1.2%) or mild to moderate angiographic changes (4.4%). Cardiac mortality thus far has occurred in nine (26%) of the 35 unoperated patients with severe correctable CAD (p = 0.033). Five-year cumulative survival for the bypass subset currently is 72%, compared with 43% in patients with severe CAD for whom myocardial revascularization was warranted but never performed (p = 0.001). At the present time, the operative risk and late survival of selected patients over 70 years of age with peripheral vascular disease appear to be especially enhanced by myocardial revascularization.



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