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Coronary Revascularization Induces a Shift From Cardiac Toward Noncardiac Mortality Without Improving Survival in Vascular Surgery Patient

2015-06Journal article Open access
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dc.contributor.authorUltee, K
dc.contributor.authorRouwet, E
dc.contributor.authorHoeks, S
dc.contributor.authorvan Lier, F
dc.contributor.authorBastos Gonçalves, F
dc.contributor.authorBoersma, E
dc.contributor.authorStolker, R
dc.contributor.authorVerhagen, H
dc.date.accessioned2015-11-20T17:23:17Z
dc.date.available2015-11-20T17:23:17Z
dc.date.issued2015-06
dc.description.abstractOBJECTIVE: 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.pt_PT
dc.identifier.citationJ Vasc Surg. 2015 Jun;61(6):1543-9.e1pt_PT
dc.identifier.doi10.1016/j.jvs.2015.01.033pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2345
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectHSM CIR VASCpt_PT
dc.subjectAortic Aneurysm, Abdominal/complicationspt_PT
dc.subjectAortic Aneurysm, Abdominal/diagnosispt_PT
dc.subjectAortic Aneurysm, Abdominal/mortalitypt_PT
dc.subjectAortic Aneurysm, Abdominal/surgery*pt_PT
dc.subjectCarotid Stenosis/complicationspt_PT
dc.subjectCarotid Stenosis/diagnosispt_PT
dc.subjectCarotid Stenosis/mortalitypt_PT
dc.subjectCarotid Stenosis/surgerypt_PT
dc.subjectCause of Deathpt_PT
dc.subjectChi-Square Distributionpt_PT
dc.subjectCoronary Artery Bypass/adverse effectspt_PT
dc.subjectCoronary Artery Bypass/mortalitypt_PT
dc.subjectHospitals, Universitypt_PT
dc.subjectKaplan-Meier Estimatept_PT
dc.subjectLife Expectancypt_PT
dc.subjectMultivariate Analysispt_PT
dc.subjectMyocardial Ischemia/complicationspt_PT
dc.subjectMyocardial Ischemia/diagnosispt_PT
dc.subjectMyocardial Ischemia/mortalitypt_PT
dc.subjectMyocardial Ischemia/therapypt_PT
dc.subjectNetherlandspt_PT
dc.subjectPercutaneous Coronary Intervention/adverse effectspt_PT
dc.subjectPercutaneous Coronary Intervention/mortalitypt_PT
dc.subjectPeripheral Arterial Disease/complicationspt_PT
dc.subjectPeripheral Arterial Disease/diagnosispt_PT
dc.subjectPeripheral Arterial Disease/mortalitypt_PT
dc.subjectPeripheral Arterial Disease/surgerypt_PT
dc.subjectPostoperative Complications/mortalitypt_PT
dc.subjectProportional Hazards Modelspt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectRisk Assessmentpt_PT
dc.subjectRisk Factorspt_PT
dc.subjectTime Factorspt_PT
dc.subjectTreatment Outcomept_PT
dc.subjectVascular Surgical Procedures/adverse effectspt_PT
dc.subjectVascular Surgical Procedures/mortalitypt_PT
dc.titleCoronary Revascularization Induces a Shift From Cardiac Toward Noncardiac Mortality Without Improving Survival in Vascular Surgery Patientpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1549pt_PT
oaire.citation.startPage1543pt_PT
oaire.citation.titleJournal of Vascular Surgerypt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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