Influence of ischemic heart disease on early and late mortality after surgery for peripheral occlusive vascular disease.

The association of coronary artery disease and peripheral vascular disease was studied to determine the influence of coronary artery disease on early and late mortality rates after surgical reconstruction for peripheral occlusive vascular disease and abdominal aortic aneurysm. Between January 1976 and December 1978, 161 consecutive patients underwent surgery for peripheral occlusive vascular disease or abdominal aortic aneurysm. The patients were 35-86 years old (mean 63.3 years). Thirty patients (18.6%) had abdominal aortic aneurysmectomies, 59 (36.7%) had aortoiliac reconstruction with or without femoropopliteal bypass and 72 (44.7%) had procedures for femoropopliteal disease. The 30-day hospital mortality rate was 6.7% for abdominal aortic aneurysm (n = 2), 3.4% for aortoiliac reconstruction (n = 2) and 1.4% for femoropopliteal procedures (n = 1). Myocardial infarction was the cause of 40% (n = 2) of the early postoperative deaths. The early mortality rate of patients with a history of angina or myocardial infarction was 5.4% (two of 37), while the early mortality rate among patients without such a history was 2.4% (three of 124). The mortality rate from myocardial infarction during the late observation period was 65% (15 of 23). The freedom from myocardial infarction was 90% at 30 months and 75% at 60 months. The overall survival rate was 87% at 30 months and 71% at 60 months. The late mortality rate was assessed with respect to various risk factors: coronary artery disease (n = 31), previous vascular surgery (n = 19) and diabetes mellitus (n = 7). Among the 63 patients who had one or more of the risk factors, the late cardiac mortality rate was 20.6% (n = 13). The late cardiac mortality rate for for the 78 patients with no risk factors was 3.8% (n = 3). An additional 10 patients with previous coronary artery bypass (n = 9) or angiography (n = 1) experienced no early or late mortality. The freedom from late cardiac death at 60 months was 71% for the high-risk group (63% patients) and 96% for the low-risk group. The study shows that coronary artery disease is a major determinant of both early and late mortality after arterial reconstruction. The status of the myocardium should be assessed before peripheral vascular surgery, as selective myocardial revascularization may improve survival in these patients.