Late results of coronary bypass in patients with peripheral vascular disease: II. Five-year survival according to sex, hypertension, and diabetes

Norman R. Hertzer, M.D. Department of Vascular Surgery The Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland, Ohio 44106 Two hundred sixteen of a series of 1000 patients initially presenting for elective surgical treatment of peripheral vascular disease underwent coronary bypass as a staged or simultaneous procedure, while bypass was warranted but never performed in 35 others who were documented by angiography to have severe coronary artery disease (CAD). Myocardial revascularization was associated with an approximate 10-fold reduction in the early mortality of vascular reconstruction, and these differences were statistically significant among hypertensive patients (p=0.045) and non-diabetics (p =0.018). During a mean follow-up interval of 4.6 years, fatal cardiac events occurred in 3.7% of patients with normal coronary arteries or mild to moderate CAD, in 12% of those receiving coronary bypass, and in 26% of the group with severe, uncorrected CAD. The protection from cardiac-related death offered by myocardial revascularization was most apparent among men (p =0.023), hypertensives (p =0.05), and nondiabetics (p =0.031). Cumulative 5-year survival after coronary bypass in men (76%) and nondiabetics (78%) exceeded that for comparable women (60%) and diabetics (43%). Because of their low operative risk (0.7%), superior 5-year survival (81%), and few late cardiac deaths (6.3%) following coronary bypass, nondiabetic men appear to have the most to gain from a comprehensive approach to associated CAD preceding peripheral vascular operations.