Author + information
- Received October 9, 2007
- Revision received November 20, 2007
- Accepted November 27, 2007
- Published online April 22, 2008.
- Gijs M.J.M. Welten, MD⁎,
- Olaf Schouten, MD⁎,
- Sanne E. Hoeks, MSc†,
- Michel Chonchol, MD§,
- Radosav Vidakovic, MD⁎,
- Ron T. van Domburg, PhD†,
- Jeroen J. Bax, MD∥,
- Marc R.H.M. van Sambeek, MD⁎ and
- Don Poldermans, MD‡,⁎ ()
- ↵⁎Reprint requests and correspondence:
Prof. Dr. Don Poldermans, Department of Anesthesiology, Erasmus MC, Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.
Objectives This study was designed to compare the long-term outcomes of patients with peripheral arterial disease (PAD) with a risk factor matched population of coronary artery disease (CAD) patients, but without PAD.
Background The PAD is considered to be a risk factor for adverse late outcome.
Methods A total of 2,730 PAD patients undergoing vascular surgery were categorized into groups: 1) carotid endarterectomy (n = 560); 2) elective abdominal aortic surgery (AAA) (n = 923); 3) acute AAA surgery (r-AAA) (n = 200), and 4) lower limb reconstruction procedures (n = 1,047). All patients were matched using the propensity score, with 2,730 CAD patients who underwent coronary angioplasty. Survival status of all patients was obtained. In addition, the cause of death and complications after surgery in PAD patients were noted. The Kaplan-Meier method was used to compare survival between the matched PAD and CAD population and the different operation groups. Prognostic risk factors and perioperative complications were identified with the Cox proportional hazards regression model.
Results The PAD patients had a worse long-term prognosis (hazard ratio 2.40, 95% confidence interval 2.18 to 2.65) and received less medication (beta-blockers, statins, angiotensin-converting enzyme inhibitors, aspirin, nitrates, and calcium antagonists) than CAD patients did (p < 0.001). Cerebro-cardiovascular complications were the major cause of long-term death (46%). Importantly, no significant difference in long-term survival was observed between the AAA and lower limb reconstruction groups (log rank p = 0.70). After vascular surgery, perioperative cardiac complications were associated with long-term cardiac death, and noncardiac complications were associated with all-cause death.
Conclusions Long-term prognosis of vascular surgery patients is significantly worse than for patients with CAD. The vascular surgery patients receive less cardiac medication than CAD patients do, and cerebro-cardiovascular events are the major cause of late death.
Dr. Schouten is supported by an unrestricted research grant from the Netherlands Organization of Health Research and Development (ZonMW), the Hague, the Netherlands. Drs. Vidakovic and Hoeks are supported by an unrestricted research grant from Lijf and Leven Foundation, Rotterdam, the Netherlands. Emile Mohler, MD, served as Guest Editor for this article.
- Received October 9, 2007.
- Revision received November 20, 2007.
- Accepted November 27, 2007.
- American College of Cardiology Foundation