Frontiers in Cardiovascular Medicine (Feb 2024)

Non-coronary atherosclerosis: a marker of poor prognosis in patients undergoing coronary artery bypass surgery

  • Óscar González-Lorenzo,
  • Juan A. Franco Pelaez,
  • Andrea Kallmeyer,
  • Luis Nieto,
  • Laura Esteban,
  • Ana Pello,
  • Álvaro Aceña,
  • Álvaro Aceña,
  • Gonzalo Aldamiz,
  • José Tuñón,
  • José Tuñón,
  • José Tuñón,
  • José Tuñón

DOI
https://doi.org/10.3389/fcvm.2024.1305162
Journal volume & issue
Vol. 11

Abstract

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IntroductionThe presence of non-coronary atherosclerosis (NCA) in patients with coronary artery disease is associated with a poor prognosis. We have studied whether NCA is also a predictor of poorer outcomes in patients undergoing coronary artery bypass grafting (CABG).Materials and methodsThis is an observational study involving 567 consecutive patients who underwent CABG. Variables and prognosis were analysed based on the presence or absence of NCA, defined as previous stroke, transient ischaemic attack (TIA), or peripheral artery disease (PAD) [lower extremity artery disease (LEAD), carotid disease, previous lower limb vascular surgery, or abdominal aortic aneurysm (AAA)]. The primary outcome was a combination of TIA/stroke, acute myocardial infarction, new revascularization procedure, or death. The secondary outcome added the need for LEAD revascularization or AAA surgery.ResultsOne-hundred thirty-eight patients (24%) had NCA. Among them, traditional cardiovascular risk factors and older age were more frequently present. At multivariate analysis, NCA [hazard ratio (HR) = 1.84, 95% confidence interval (CI) 1.27–2.69], age (HR = 1.35, 95% CI 1.09–1.67, p = 0.004), and diabetes mellitus (HR = 1.50, 95% CI 1.05–2.15, p = 0.025), were positively associated with the development of the primary outcome, while estimated glomerular filtration rate (HR = 0.86, 95% CI 0.80–0.93, p = 0.001) and use of left internal mammary artery (HR = 0.36, 95% CI 0.15–0.82, p = 0.035), were inversely associated with this outcome. NCA was also an independent predictor of the secondary outcome. Mortality was also higher in NCA patients (27.5% vs. 9%, p < 0.001).ConclusionsAmong patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.

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