Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.17/2345
Título: Coronary Revascularization Induces a Shift From Cardiac Toward Noncardiac Mortality Without Improving Survival in Vascular Surgery Patient
Autor: Ultee, K
Rouwet, E
Hoeks, S
van Lier, F
Bastos Gonçalves, F
Boersma, E
Stolker, R
Verhagen, H
Palavras-chave: HSM CIR VASC
Aortic Aneurysm, Abdominal/complications
Aortic Aneurysm, Abdominal/diagnosis
Aortic Aneurysm, Abdominal/mortality
Aortic Aneurysm, Abdominal/surgery*
Carotid Stenosis/complications
Carotid Stenosis/diagnosis
Carotid Stenosis/mortality
Carotid Stenosis/surgery
Cause of Death
Chi-Square Distribution
Coronary Artery Bypass/adverse effects
Coronary Artery Bypass/mortality
Hospitals, University
Kaplan-Meier Estimate
Life Expectancy
Multivariate Analysis
Myocardial Ischemia/complications
Myocardial Ischemia/diagnosis
Myocardial Ischemia/mortality
Myocardial Ischemia/therapy
Netherlands
Percutaneous Coronary Intervention/adverse effects
Percutaneous Coronary Intervention/mortality
Peripheral Arterial Disease/complications
Peripheral Arterial Disease/diagnosis
Peripheral Arterial Disease/mortality
Peripheral Arterial Disease/surgery
Postoperative Complications/mortality
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Vascular Surgical Procedures/adverse effects
Vascular Surgical Procedures/mortality
Data: Jun-2015
Editora: Elsevier
Citação: J Vasc Surg. 2015 Jun;61(6):1543-9.e1
Resumo: OBJECTIVE: Although evidence has shown that ischemic heart disease (IHD) in vascular surgery patients has a negative impact on the prognosis after surgery, it is unclear whether directed treatment of IHD may influence cause-specific and overall mortality. The objective of this study was to determine the prognostic implication of coronary revascularization (CR) on overall and cause-specific mortality in vascular surgery patients. METHODS: Patients undergoing surgery for abdominal aortic aneurysm, carotid artery stenosis, or peripheral artery disease in a university hospital in The Netherlands between January 2003 and December 2011 were retrospectively included. Survival estimates were obtained by Kaplan-Meier and Cox regression analysis. RESULTS: A total of 1104 patients were included. Adjusted survival analyses showed that IHD significantly increased the risk of overall mortality (hazard ratio [HR], 1.50; 95% confidence interval, 1.21-1.87) and cardiovascular death (HR, 1.93; 95% confidence interval, 1.35-2.76). Compared with those without CR, patients previously undergoing CR had similar overall mortality (HR, 1.38 vs 1.62; P = .274) and cardiovascular mortality (HR, 1.83 vs 2.02; P = .656). Nonrevascularized IHD patients were more likely to die of IHD (6.9% vs 35.7%), whereas revascularized IHD patients more frequently died of cardiovascular causes unrelated to IHD (39.1% vs 64.3%; P = .018). CONCLUSIONS: This study confirms the significance of IHD for postoperative survival of vascular surgery patients. CR was associated with lower IHD-related death rates. However, it failed to provide an overall survival benefit because of an increased rate of cardiovascular mortality unrelated to IHD. Intensification of secondary prevention regimens may be required to prevent this shift toward non-IHD-related death and thereby improve life expectancy.
Peer review: yes
URI: http://hdl.handle.net/10400.17/2345
DOI: 10.1016/j.jvs.2015.01.033
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