Abstract 11187: Three-year Clinical Outcomes in Patients with Polyvascular Disease Undergoing Coronary Revascularization: A Report from the CREDO-Kyoto Registry Cohort-2
Background: Patients with coronary artery disease often have concomitant cerebral, aortic or peripheral vascular disease. However, clinical outcomes after coronary revascularization in patients with polyvascular disease have not been fully elucidated.
Methods: In the CREDO-Kyoto registry Cohort-2, we identified 15263 patients undergoing first coronary revascularization from January 2005 to December 2007. Patients were divided into 4 groups according to the presence of prior stroke or extracardiac vascular disease (EVD). Prior stroke included both ischemic and hemorrhagic stroke. Carotid, aortic or other peripheral vascular disease were defined as EVD. Among 15263 patients, there were 1443 patients with prior stroke (stoke group), 974 patients with EVD (EVD group), 253 patients with prior stroke and EVD (stoke and EVD group) and 12593 patients without prior stroke or EVD (reference group).
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 prior stroke or EVD compared with reference patients (11.2% in the reference group, 19.9% in the stroke group, 18.5% in the EVD group and 20.1% in the stroke and EVD group, P<0.0001). In multivariate analysis, the risk for MACE was significantly higher in the stroke group (adjusted HR 1.34 [95%CI 1.17-1.54], P<0.0001), in the EVD group (adjusted HR 1.56 [95%CI 1.32-1.84], P<0.0001) and in the stroke and EVD group (adjusted HR 1.66 [95%CI 1.24-2.23], P=0.0007) compared with the reference group. The risk for all-cause death was also significantly higher in the stroke group (adjusted HR 1.22 [95%CI 1.05-1.42], P=0.01), in the EVD group (adjusted HR 1.54 [95%CI 1.28-1.84], P<0.0001) and in the stroke and EVD group (adjusted HR 1.77 [95%CI 1.29-2.43], P=0.0004) compared with the reference group.
Conclusions: Clinical outcomes after coronary revascularization are worse in patients with stroke or EVD, with the highest risk in those with the 2 conditions. Identification of these patients may provide an opportunity to reduce their excess risk with intensive secondary prevention efforts.
- © 2012 by American Heart Association, Inc.