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Ann Thorac Surg 2004;78:466-470
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Survival in patients with peripheral vascular disease after percutaneous coronary intervention and coronary artery bypass graft surgery

Daniel J. O'Rourke, MD, MSa,b*, Hebe B. Quinton, BA, MSc, Winthrop Piper, MSc, Felix Hernandez, MDd, Jeremy Morton, MDe, Bruce Hettleman, MDb, Michael Hearne, MDf, William Nugent, MDg, Gerald T. O'Connor, PhD, DScc, David J. Malenka, MDb Northern New England Cardiovascular Disease Study Group

a Section of Cardiology, Veterans Affairs Hospital, White River Junction, Vermont, USA
b Section of Cardiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
g Section of Cardiothoracic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
c Section of Clinical Research, Dartmouth Medical School, Hanover, New Hampshire, USA
d Section of Cardiothoracic Surgery, Eastern Maine Medical Center, Bangor, Maine, USA
e Section of Cardiothoracic Surgery, Maine Medical Center, Portland, Maine, USA
f Section of Cardiology, Catholic Medical Center, Manchester, New Hampshire, USA

Accepted for publication January 22, 2004.

* Address reprint requests to Dr O'Rourke, Medical Service-Cardiology, Veterans Affairs Medical Center, Hartland Rd, White River Junction, VT 05006, USA
e-mail: daniel.o'rourke{at}hitchcock.org

BACKGROUND: Patients with peripheral vascular disease (PVD) undergoing coronary revascularization have high rates of adverse outcomes. Whether there are important differences in outcomes for surgical versus percutaneous coronary revascularization is unknown. The objective of this study was to compare survival in patients with PVD who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) surgery for multivessel coronary artery disease.

METHODS: In-hospital data were collected on 1,305 consecutive patients undergoing coronary revascularization (PCI, n = 341; CABG, n = 964) in northern New England from 1994 to 1996. Patient records were linked to the National Death Index to assess survival out to 3 years (mean 1.2 years). Logistic and Cox proportional hazards regression were used to calculate risk-adjusted odds ratios and hazard ratios.

RESULTS: Compared with CABG patients, those undergoing PCI were more often women, had more renal failure, more prior coronary revascularizations, were more likely to have two-vessel coronary artery disease and were more likely to undergo the procedure emergently. They were less likely to have a history of heart failure. After adjusting for differences in baseline characteristics, patients undergoing CABG had better intermediate survival than did PCI patients (hazard ratio 0.68; 95% confidence interval, 0.46 to 1.00; p = 0.05).

CONCLUSIONS: Patients with multivessel coronary artery disease and PVD undergoing CABG surgery have better intermediate survival out to 3 years than similar patients undergoing PCI. This information may be useful in counseling patients with PVD requiring coronary revascularization.




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