González-Lorenzo Óscar, Franco Pelaez Juan A, Kallmeyer Andrea, Nieto Luis, Esteban Laura, Pello Ana, Aceña Álvaro, Aldamiz Gonzalo, Tuñón José
Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
Faculty of Medicine, Autónoma University, Madrid, Spain.
Front Cardiovasc Med. 2024 Feb 23;11:1305162. doi: 10.3389/fcvm.2024.1305162. eCollection 2024.
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).
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.
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, = 0.004), and diabetes mellitus (HR = 1.50, 95% CI 1.05-2.15, = 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, = 0.001) and use of left internal mammary artery (HR = 0.36, 95% CI 0.15-0.82, = 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%, < 0.001).
Among patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.
冠心病患者中非冠状动脉粥样硬化（NCA）的存在与预后不良相关。我们研究了NCA是否也是冠状动脉旁路移植术（CABG）患者预后较差的预测因素。
这是一项观察性研究，纳入了567例连续接受CABG的患者。根据是否存在NCA分析变量和预后，NCA定义为既往中风、短暂性脑缺血发作（TIA）或外周动脉疾病（PAD）[下肢动脉疾病（LEAD）、颈动脉疾病、既往下肢血管手术或腹主动脉瘤（AAA）]。主要结局是TIA/中风、急性心肌梗死、新的血运重建手术或死亡的组合。次要结局增加了LEAD血运重建或AAA手术的需求。
138例患者（24%）存在NCA。其中，传统心血管危险因素和高龄更为常见。多因素分析显示，NCA[风险比（HR）=1.84，95%置信区间（CI）1.27 - 2.69]、年龄（HR = 1.35，95% CI 1.09 - 1.67，P = 0.004）和糖尿病（HR = 1.50，95% CI 1.05 - 2.15，P = 0.025）与主要结局的发生呈正相关，而估计肾小球滤过率（HR = 0.86，95% CI 0.80 - 0.93，P = 0.001）和左乳内动脉的使用（HR = 0.36，95% CI 0.15 - 0.82，P = 0.035）与该结局呈负相关。NCA也是次要结局的独立预测因素。NCA患者的死亡率也更高（27.5%对9%，P < 0.001）。
在接受CABG的患者中，NCA的存在使发生心血管事件的风险增加一倍，且与更高的死亡率相关。
