LATE NONFATAL AND FATAL CARDIAC EVENTS AFTER INFRAINGUINAL BYPASS FOR FEMOROPOPLITEAL OCCLUSIVE DISEASE DURING A 31-YEAR PERIOD

Purpose and Methods: In patients with peripheral vascular disease the complications of associated coronary artery disease have always been a leading cause of morbidity and mortality. Therefore we evaluated the risk for late cardiac morbidity and mortality in 376 consecutive patients after infrainguinal bypass. Follow-up was complete for 373 patients (99.3%) with a mean follow-up period of 5.9 years. After operation all but four patients were treated with lifelong warfarin (Coumadin therapy.) Results. During follow-up 129 patients (34.3%) had 183 late cardiac events. Of these patients, 79 (61.2%) died of late cardiac events and 13 (10.0%) required either coronary angioplasty or bypass. The risk of late cardiac events was 34% at 5 years and increased to 56% at 15 years. Multivariate analysis demonstrated that age, cardiac disease, and impaired renal function at the time of operation were associated with an increased risk of cardiac events during follow-up. Independent predictors of cardiac death were age, cardiac disease, hypertension, diabetes, and impaired renal function. Morbidity and mortality was particularly high in patients with critical ischemia. The subset of patients with claudication had a life expectancy that appeared to be similar to that of a matched sample of the normal population. Conclusions: Our findings clearly demonstrate that some patients undergoing infrainguinal bypass are at high risk for late cardiac events of which many are fatal, whereas others may have an almost normal life expectancy. Most important, the occurrence of cardiac events may be predicted by simple and readily obtainable clinical variables at the time of the initial infrainguinal bypass procedure. Because these events were related to late cardiac death, this may be the key for angiographic evaluation and possible prevention of cardiac death.