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Coronary artery revascularization before peripheral vascular surgery in patients with peripheral arterial disease

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Abstract

The prevalence of coronary artery disease (CAD) in patients with peripheral arterial disease (PAD) approaches 50%. The incidence of perioperative cardiac complications is high in patients undergoing peripheral vascular surgery (PVS). However, the long-term efficacy of coronary artery revascularization in patients with PAD prior to PVS remains controversial. We retrospectively analyzed the long-term outcomes of 114 patients who underwent elective PVS. Coronary angiography (CAG) was performed routinely in all patients prior to the surgery. Preoperative CAG revealed CAD in 52 patients and no CAD in 62 patients (No-CAD group). Of the 52 patients with CAD, 15 patients with effort angina (more than CCS class 2), myocardial ischemia proven by pharmacological stress scintigraphy, and/or multivessel disease with impaired left ventricular systolic function underwent coronary revascularization (CAD-R group). The remaining 37 patients with CAD were treated medically (CAD-M group). The rates of postoperative events within 30 days were 26.7% in the CAD-R group, 10.8% in the CAD-M group, and 8.1% in the No-CAD group, respectively (P = 0.13), and the rates of long-term cardiovascular events were 33.3, 21.6, and 21.0%, respectively (P = 0.60). Therefore, the acute and long-term clinical outcomes in the CAD-R group were comparable with the other groups. In this study, the patients with CAD who showed inducible myocardial ischemia and/or multivessel disease with impaired left ventricular systolic function underwent coronary artery revascularization prior to the elective PVS. The patients who underwent coronary revascularization prior to the PVS exhibited comparable long-term outcomes compared with the patients who showed CAD but without inducible myocardial ischemia and with those without CAD. These data suggest that the evaluation of CAD and myocardial ischemia to determine the therapeutic strategy for CAD before elective PVS would be needed.

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Authors and Affiliations

  1. Division of Cardiology, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan

    Hideki Miyachi, Jun Tanabe, Mitsunobu Kitamura, Asako Sasaki, Michio Ogano & Kunito Shiiba

  2. The Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan

    Eitaro Kodani, Yusuke Hosokawa & Yoshiki Kusama

  3. The Division of Cardiovascular Surgery, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan

    Hisato Takagi & Takuya Umemoto

  4. The First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan

    Kyoichi Mizuno

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  1. Hideki Miyachi
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  2. Jun Tanabe
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  3. Eitaro Kodani
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  4. Yusuke Hosokawa
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  7. Michio Ogano
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  8. Kunito Shiiba
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  9. Hisato Takagi
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  11. Yoshiki Kusama
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  12. Kyoichi Mizuno
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Correspondence to Hideki Miyachi.

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Miyachi, H., Tanabe, J., Kodani, E. et al. Coronary artery revascularization before peripheral vascular surgery in patients with peripheral arterial disease. Cardiovasc Interv and Ther 25, 11–17 (2010). https://doi.org/10.1007/s12928-009-0001-8

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  • DOI: https://doi.org/10.1007/s12928-009-0001-8

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