Presence of PAD May Increase Risk for Stroke, Limb Ischemia After CABG

Patients with vs without peripheral artery disease (PAD) may be at higher risk for stroke, acute kidney disease, and limb ischemia after coronary artery bypass grafting (CABG) surgery, according to a study published in Heart, Lung, and Circulation.

This study is a retrospective analysis of consecutive patients who underwent CABG performed by 3 interventionalists in Italy and Albania between 1997 and 2017 (n=11,311; with PAD, n=1961; without PAD, n=9350). The study’s primary endpoints included mortality of any cause or stroke within 30 days of surgery and postoperative limb ischemia requiring surgical and/or percutaneous revascularization.

The mortality rate was comparable in patients with vs without PAD (1.6%; 95% CI, −0.6 to 4.0; P =.06). Patients with vs without PAD had a higher incidence of stroke (1.4%; 95% CI, 0.02-2.8; P =.04), of acute kidney disease (3.0%; 95% CI, 1.0-5.1; P =.03), and of postoperative acute limb ischemia (10%; 95% CI, 9.3-11.5; P <.001).

The rate of mortality was comparable with the use of on- vs off-pump techniques (P =.08), or off-pump coronary artery bypass no touch vs off-pump coronary artery bypass side-clamp techniques (P =.6) during CABG surgery. Postoperative low cardiac output syndrome was associated with increased mortality in patients with vs without PAD (P =.01).

Study limitations include its retrospective and observational nature, which may limit the generalizability of the findings.

“The choice of vascular surgery before or concomitant with CABG should be patient-tailored and taken into account with the patient’s clinical conditions,” concluded the study authors.

Reference

Bonacchi M, Parise O, Matteucci F, et al. Is peripheral artery disease an independent predictor of isolated coronary artery bypass outcome [published online February 20, 2020]? Heart Lung Circ. doi:10.1016/j.hlc.2020.01.013