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. 2024 Feb 23:11:1305162.
doi: 10.3389/fcvm.2024.1305162. eCollection 2024.

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

Óscar González-Lorenzo  1 , Juan A Franco Pelaez  1 , Andrea Kallmeyer  1 , Luis Nieto  1 , Laura Esteban  1 , Ana Pello  1 , Álvaro Aceña  1   2 , Gonzalo Aldamiz  3 , José Tuñón  1   2   4   5
Affiliations

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

Óscar González-Lorenzo et al. Front Cardiovasc Med. .

Abstract

Introduction: The 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 methods: This 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.

Results: One-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).

Conclusions: Among patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.

Keywords: cardiovascular risk factors; coronary artery bypass grafting (CABG); peripheral artery disease (PAD); stroke; transient ischaemic attack (TIA).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Final Cox regression multivariate model for the occurrence of the primary outcome. 1For each 10 years increase. 2For each 10 ml/min/1.73 m2 increase. eGFR: Estimated glomerular filtration rate by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration equation). LIMA, left internal mammary artery; NCA, non-coronary atherosclerosis.
Figure 2
Figure 2
Kaplan-Meier curves for the primary outcome. NCA, non-coronary atherosclerosis.
Figure 3
Figure 3
Kaplan-Meier curves for the secondary outcome. NCA, Non-coronary atherosclerosis.
See this image and copyright information in PMC

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