AUTHOR=González-Lorenzo Óscar , Franco Pelaez Juan A. , Kallmeyer Andrea , Nieto Luis , Esteban Laura , Pello Ana , Aceña Álvaro , Aldamiz Gonzalo , Tuñón José TITLE=Non-coronary atherosclerosis: a marker of poor prognosis in patients undergoing coronary artery bypass surgery JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=11 YEAR=2024 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1305162 DOI=10.3389/fcvm.2024.1305162 ISSN=2297-055X ABSTRACT=Introduction

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).

Materials and methods

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.

Results

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, p = 0.004), and diabetes mellitus (HR = 1.50, 95% CI 1.05–2.15, p = 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, p = 0.001) and use of left internal mammary artery (HR = 0.36, 95% CI 0.15–0.82, p = 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%, p < 0.001).

Conclusions

Among patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.