Late results of Coronary Bypass in Patients Presenting with Lower Extremity Ischemia: the Cleveland Clinic Study

Cardiac catheterization was performed in a prospective series of 1000 patients under consideration for elective peripheral vascular reconstruction from 1978–1982. Of these, 381 (mean age 62) presented primarily because of lower extremity ischemia. Severa, surgically correctable coronary artery disease (CAD) was documented in 79 (21 %) of the leg group, and 68 (18 %) received myocardial revascularization, with three fatal complications (4.4 %). In this subset, 39 patients have had uneventful aortoiliac, femoropopliteal or distal extremity procedures, compared to an operative mortality of 23 % for 13 others with uncorrected or inoperable CAD (p=0.015). A total of 286 patients have undergone 407 peripheral vascular operations with eight early daths (2.8 %). An additional 114 patients (30 %) died during the late follow-up interval, including 48 (13 %) with cardiac events. Both the cumulative 5-year survival (72 %) and cardiac mortality (16 %) after coronary bypass are superior to comparable figures (21 % and 56 %, respectively) among 36 other patients with severe, uncorrected or inoperable CAD (p=0.0001). Five-year survival appears to be improved by myocardical revascularization in men (p=0.0027), hypertensives (p=0.0001), nondiabetics (p=0.0002) and those over 60 years of age (p=0.0072).