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Impact of polyvascular disease on clinical outcomes in patients undergoing coronary revascularization: An observation from the CREDO-Kyoto Registry Cohort-2

      Highlights

      • Patients with coronary artery disease often have concomitant vascular disease.
      • Outcomes after revascularization were assessed in patients with polyvascular disease.
      • Patients with polyvascular disease had worse cardiovascular outcomes.

      Abstract

      Objective

      Patients with coronary artery disease (CAD) often have prior stroke or concomitant extra-cardiac vascular disease (EVD) such as cerebral, aortic, or peripheral vascular disease. However, clinical outcomes after coronary revascularization in patients with polyvascular disease have not been fully elucidated.

      Methods

      Among 15,263 patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto registry Cohort-2 from January 2005 to December 2007, there were 1443 patients with prior stroke (stroke + CAD group), 974 patients with EVD (EVD + CAD group), 253 patients with both prior stroke and EVD (stroke/EVD/CAD group) and 12,593 patients with neither prior stroke nor EVD (CAD alone group [reference]).

      Results

      The cumulative incidence of major adverse cardiovascular events (MACE: composite of cardiovascular death, myocardial infarction and stroke) through 3 years was significantly higher in patients with polyvascular disease compared with reference patients (19.9% in the stroke + CAD group, 18.5% in the EVD + CAD group, 20.1% in the stroke/EVD/CAD group, and 11.2% in the CAD alone group, P < 0.0001). After adjusting confounders, the presence of EVD and/or stroke was independently associated with higher risk for MACE compared with the reference group (adjusted HR [95%CI]: 1.34 [1.17–1.54], P < 0.0001 in the stroke + CAD group, 1.56 [1.32–1.84], P < 0.0001 in the EVD + CAD group, and 1.66 [1.24–2.23], P = 0.0007 in the stroke/EVD/CAD group). However, the presence of EVD and/or stroke was not associated with higher risk for myocardial infarction.

      Conclusions

      Clinical outcome after coronary revascularization was worse in patients with prior stroke and/or EVD, which was mainly driven by the increased risk for non-coronary cardiovascular events.

      Keywords

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      References

        • Norgren L.
        • Hiatt W.R.
        • Dormandy J.A.
        • Nehler M.R.
        • Harris K.A.
        • Fowkes F.G.
        Inter-society consensus for the management of peripheral arterial disease (TASC II).
        J Vasc Surg. 2007; 45: S5-67
        • Yokota C.
        • Minematsu K.
        • Hasegawa Y.
        • Yamaguchi T.
        Long-term prognosis, by stroke subtypes, after a first-ever stroke: a hospital-based study over a 20-year period.
        Cerebrovas Dis. 2004; 18: 111-116
        • Takigawa M.
        • Yokoyama N.
        • Yoshimuta T.
        • Takeshita S.
        Prevalence and prognosis of asymptomatic coronary artery disease in patients with abdominal aortic aneurysm and minor or no perioperative risks.
        Circ J. 2009; 73: 1203-1209
        • Hirose K.
        • Chikamori T.
        • Hida S.
        • et al.
        Prevalence of coronary heart disease in patients with aortic aneurysm and/or peripheral artery disease.
        Am J Cardiol. 2009; 103: 1215-1220
        • Shimada T.
        • Toyoda K.
        • Inoue T.
        • et al.
        Prediction of coronary artery disease in patients undergoing carotid endarterectomy.
        J Neurosurg. 2005; 103: 593-596
        • Dormandy J.A.
        • Rutherford R.B.
        Management of peripheral arterial disease (PAD). TASC working group. TransAtlantic inter-Society Consensus (TASC).
        J Vasc Surg. 2000; 31: S1-S296
        • Bhatt D.L.
        • Steg P.G.
        • Ohman E.M.
        • et al.
        International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis.
        JAMA. 2006; 295: 180-189
        • Bhatt D.L.
        • Eagle K.A.
        • Ohman E.M.
        • et al.
        Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis.
        JAMA. 2010; 304: 1350-1357
        • Bhatt D.L.
        • Peterson E.D.
        • Harrington R.A.
        • et al.
        Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes.
        Eur Heart J. 2009; 30: 1195-1202
        • Mukherjee D.
        • Eagle K.A.
        • Kline-Rogers E.
        • et al.
        Impact of prior peripheral arterial disease and stroke on outcomes of acute coronary syndromes and effect of evidence-based therapies (from the global registry of acute coronary events).
        Am J Cardiol. 2007; 100: 1-6
        • Cotter G.
        • Cannon C.P.
        • McCabe C.H.
        • et al.
        Prior peripheral arterial disease and cerebrovascular disease are independent predictors of adverse outcome in patients with acute coronary syndromes: are we doing enough? Results from the orbofiban in patients with unstable coronary syndromes-thrombolysis in myocardial infarction (OPUS-TIMI) 16 study.
        Am Heart J. 2003; 145: 622-627
        • Kimura T.
        • Morimoto T.
        • Furukawa Y.
        • et al.
        Long-term safety and efficacy of sirolimus-eluting stents versus bare-metal stents in real world clinical practice in Japan.
        Cardiovasc Interv Ther. 2011; 26: 234-245
        • Natsuaki M.
        • Furukawa Y.
        • Morimoto T.
        • et al.
        Intensity of statin therapy, achieved low-density lipoprotein cholesterol levels and cardiovascular outcomes in Japanese patients after coronary revascularization. Perspectives from the CREDO-Kyoto Registry cohort-2.
        Circ J. 2012; 76: 1369-1379
        • Eagle K.A.
        • Rihal C.S.
        • Foster E.D.
        • Mickel M.C.
        • Gersh B.J.
        Long-term survival in patients with coronary artery disease: importance of peripheral vascular disease. The coronary artery surgery study (CASS) investigators.
        J Am Coll Cardiol. 1994; 23: 1091-1095
        • Saw J.
        • Bhatt D.L.
        • Moliterno D.J.
        • et al.
        The influence of peripheral arterial disease on outcomes: a pooled analysis of mortality in eight large randomized percutaneous coronary intervention trials.
        J Am Coll Cardiol. 2006; 48: 1567-1572
        • Nallamothu B.K.
        • Chetcuti S.
        • Mukherjee D.
        • et al.
        Long-term prognostic implication of extracardiac vascular disease in patients undergoing percutaneous coronary intervention.
        Am J Cardiol. 2003; 92: 964-966
        • Subherwal S.
        • Bhatt D.L.
        • Li S.
        • et al.
        Polyvascular disease and long-term cardiovascular outcomes in older patients with non-ST-segment-elevation myocardial infarction.
        Circ Cardiovasc Qual Outcomes. 2012; 5: 541-549
        • Ducrocq G.
        • Amarenco P.
        • Labreuche J.
        • et al.
        A history of stroke/transient ischemic attack indicates high risks of cardiovascular event and hemorrhagic stroke in patients with coronary artery disease.
        Circulation. 2013; 127: 730-738
        • Kimura T.
        • Morimoto T.
        • Nakagawa Y.
        • et al.
        Very late stent thrombosis and late target lesion revascularization after sirolimus-eluting stent implantation: five-year outcome of the j-Cypher registry.
        Circulation. 2012; 125: 584-591
        • Steg P.G.
        • Bhatt D.L.
        • Wilson P.W.
        • et al.
        One-year cardiovascular event rates in outpatients with atherothrombosis.
        JAMA. 2007; 297: 1197-1206
        • Hirsch A.T.
        • Criqui M.H.
        • Treat-Jacobson D.
        • et al.
        Peripheral arterial disease detection, awareness, and treatment in primary care.
        JAMA. 2001; 286: 1317-1324
        • Hirsch A.T.
        • Murphy T.P.
        • Lovell M.B.
        • et al.
        Gaps in public knowledge of peripheral arterial disease: the first national pad public awareness survey.
        Circulation. 2007; 116: 2086-2094
        • Blacher J.
        • Cacoub P.
        • Luizy F.
        • et al.
        Peripheral arterial disease versus other localizations of vascular disease: the ATTEST study.
        J Vasc Surg. 2006; 44: 314-318