Impact of peripheral arterial disease on short-term clinical outcomes after coronary artery bypass grafting: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Yuqiu ¹ , CHEN Si ² , LI Geng ² ,  SHAO Yongfeng ¹ ,  JIANG Yefan ^1,2

1. Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P. R. China;
2. Department of Cardiothoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, P. R. China;

Corresponding author：

SHAO Yongfeng, Email: shaoyongfeng@hotmail.com; JIANG Yefan, Email: xkwjyf@njmu.edu.cn

Keywords：

Peripheral artery disease; coronary artery bypass grafting; age stratification; propensity score matching

DOI：

10.7507/1007-4848.202506062

Video：

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Objective To investigate the impact of peripheral artery disease (PAD) on the short-term prognosis after coronary artery bypass grafting (CABG) in patients of different age groups. Methods Retrospective inclusion of patients who underwent CABG at Tongji Medical College Affiliated Union Hospital of Huazhong University of Science and Technology from 2016 to 2020. Divided into four groups by age (<50 years, 50-60 years, 60-70 years, >70 years). Propensity score matching (PSM) was used to balance the baseline characteristics of PAD and non PAD patients across different age groups. The primary endpoint of the study was all-cause mortality, and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) during the perioperative period. Results Totally, 1 516 patients were enrolled, including the GroupⅠ (<50 years, n=167), Group Ⅱ (50-60 years, n=477), Group Ⅲ (60-70 years, n=688), and Group Ⅳ (>70 years, n=184). After PSM treatment, a total of 375 pairs of patients (75.2% male) were successfully matched. Only in the age group of 60-70 years, the in-hospital mortality rate (7.73% vs. 1.45%, P＜0.01) and MACCE incidence rate (21.26% vs. 13.04%, P=0.02) of PAD patients were significantly higher than those of the non PAD group. Further multivariate analysis suggests that PAD is an independent risk factor for in-hospital mortality (OR=3.96, P＜0.01) and MACCE (OR=1.58, P=0.04) in this group, while there is no statistically significant difference in other age groups. Conclusion: PAD significantly increases the risk of recent mortality and MACCE in CABG patients aged 60-70 years, and perioperative management needs to be optimized for this population.

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2.	Dormandy J, Heeck L, Vig S. Lower-extremity arteriosclerosis as a reflection of a systemic process: implications for concomitant coronary and carotid disease. Semin Vasc Surg, 1999, 12(2): 118-122.
3.	van Straten AH, Firanescu C, Soliman Hamad MA, et al. Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population. Ann Thorac Surg, 2010, 89(2): 414-420.
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8.	Deb S, Austin PC, Tu JV, et al. A review of propensity-score methods and their use in cardiovascular research. Can J Cardiol, 2016, 32(2): 259-265.
9.	Steg PG, Bhatt DL, Wilson PW, et al. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA, 2007, 297(11): 1197-1206.
10.	Austin PC, Schuster T. The performance of different propensity score methods for estimating absolute effects of treatments on survival outcomes: a simulation study. Stat Methods Med Res, 2016, 25(5): 2214-2237.
11.	Muir RL. Peripheral arterial disease: pathophysiology, risk factors, diagnosis, treatment, and prevention. J Vasc Nurs, 2009, 27(2): 26-30.
12.	Harskamp RE, Alexander JH, Schulte PJ, et al. Impact of extracardiac vascular disease on vein graft failure and outcomes after coronary artery bypass surgery. Ann Thorac Surg, 2014, 97(3): 824-830.
13.	Collison T, Smith JM, Engel AM. Peripheral vascular disease and outcomes following coronary artery bypass graft surgery. Arch Surg, 2006, 141(12): 1214-1218.
14.	Chu D, Bakaeen FG, Wang XL, et al. The impact of peripheral vascular disease on long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg, 2008, 86(4): 1175-1180.
15.	Bonacchi M, Parise O, Matteucci F, et al. Early outcomes following isolated coronary artery bypass surgery: influence of peripheral artery disease. J Card Surg, 2019, 34(12): 1470-1477.
16.	Raja SG. Myocardial revascularization for the elderly: current options, role of off-pump coronary artery bypass grafting and outcomes. Curr Cardiol Rev, 2012, 8(1): 26-36.
17.	Baig K, Harling L, Papanikitas J, et al. Does coronary artery bypass grafting improve quality of life in elderly patients? Interact Cardiovasc Thorac Surg, 2013, 17(3): 542-553.
18.	Lakatta EG. Changes in cardiovascular function with aging. Eur Heart J, 1990, 11 Suppl C: 22-9.11-22.
19.	Loran DB, Zwischenberger JB. Thoracic surgery in the elderly. J Am Coll Surg, 2004, 199(5): 773-784.
20.	D'Agostino RS, Svensson LG, Neumann DJ, et al. Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients. Ann Thorac Surg, 1996, 62(6): 1714-1723.
21.	Triposkiadis F, Xanthopoulos A, Butler J. Cardiovascular aging and heart failure: JACC review topic of the week. J Am Coll Cardiol, 2019, 74(6): 804-813.

1. Cassar A, Poldermans D, Rihal CS, et al. The management of combined coronary artery disease and peripheral vascular disease. Eur Heart J, 2010, 31(13): 1565-1572.
2. Dormandy J, Heeck L, Vig S. Lower-extremity arteriosclerosis as a reflection of a systemic process: implications for concomitant coronary and carotid disease. Semin Vasc Surg, 1999, 12(2): 118-122.
3. van Straten AH, Firanescu C, Soliman Hamad MA, et al. Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population. Ann Thorac Surg, 2010, 89(2): 414-420.
4. Wu C, Camacho FT, Wechsler AS, et al. Risk score for predicting long-term mortality after coronary artery bypass graft surgery. Circulation, 2012, 125(20): 2423-2430.
5. Luther M, Lepäntalo M. Femorotibial reconstructions for chronic critical leg ischaemia: influence on outcome by diabetes, gender and age. Eur J Vasc Endovasc Surg, 1997, 13(6): 569-577.
6. Yanaka K, Akahori H, Imanaka T, et al. The impact of peripheral artery disease on left ventricular diastolic function. J Cardiol, 2019, 73(6): 453-458.
7. Wang JC, Bennett M. Aging and atherosclerosis: mechanisms, functional consequences, and potential therapeutics for cellular senescence. Circ Res, 2012, 111(2): 245-259.
8. Deb S, Austin PC, Tu JV, et al. A review of propensity-score methods and their use in cardiovascular research. Can J Cardiol, 2016, 32(2): 259-265.
9. Steg PG, Bhatt DL, Wilson PW, et al. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA, 2007, 297(11): 1197-1206.
10. Austin PC, Schuster T. The performance of different propensity score methods for estimating absolute effects of treatments on survival outcomes: a simulation study. Stat Methods Med Res, 2016, 25(5): 2214-2237.
11. Muir RL. Peripheral arterial disease: pathophysiology, risk factors, diagnosis, treatment, and prevention. J Vasc Nurs, 2009, 27(2): 26-30.
12. Harskamp RE, Alexander JH, Schulte PJ, et al. Impact of extracardiac vascular disease on vein graft failure and outcomes after coronary artery bypass surgery. Ann Thorac Surg, 2014, 97(3): 824-830.
13. Collison T, Smith JM, Engel AM. Peripheral vascular disease and outcomes following coronary artery bypass graft surgery. Arch Surg, 2006, 141(12): 1214-1218.
14. Chu D, Bakaeen FG, Wang XL, et al. The impact of peripheral vascular disease on long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg, 2008, 86(4): 1175-1180.
15. Bonacchi M, Parise O, Matteucci F, et al. Early outcomes following isolated coronary artery bypass surgery: influence of peripheral artery disease. J Card Surg, 2019, 34(12): 1470-1477.
16. Raja SG. Myocardial revascularization for the elderly: current options, role of off-pump coronary artery bypass grafting and outcomes. Curr Cardiol Rev, 2012, 8(1): 26-36.
17. Baig K, Harling L, Papanikitas J, et al. Does coronary artery bypass grafting improve quality of life in elderly patients? Interact Cardiovasc Thorac Surg, 2013, 17(3): 542-553.
18. Lakatta EG. Changes in cardiovascular function with aging. Eur Heart J, 1990, 11 Suppl C: 22-9.11-22.
19. Loran DB, Zwischenberger JB. Thoracic surgery in the elderly. J Am Coll Surg, 2004, 199(5): 773-784.
20. D'Agostino RS, Svensson LG, Neumann DJ, et al. Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients. Ann Thorac Surg, 1996, 62(6): 1714-1723.
21. Triposkiadis F, Xanthopoulos A, Butler J. Cardiovascular aging and heart failure: JACC review topic of the week. J Am Coll Cardiol, 2019, 74(6): 804-813.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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