Impact of polyvascular disease on clinical outcomes in patients undergoing coronary revascularization: An observation from the CREDO-Kyoto Registry Cohort-2

Abstract Objective Patients with coronary artery disease ( CAD) often have prior strokeor concomitant extra-cardiac vascular disease(EVD) such as cerebral, aortic, or peripheral vascular disease. However, clinical outcomes after coronary revascularizationin patients with polyvascular disease have not been fully elucidated. Methods Among 15,263 patients undergoing first coronary revascularizationenrolled in the CREDO-Kyoto registry Cohort-2 from January 2005 to December 2007, there were 1443 patients with prior stroke( stroke+ CADgroup), 974 patients with EVD (EVD + CADgroup), 253 patients with both prior strokeand EVD ( stroke/EVD/ CADgroup) and 12,593 patients with neither prior strokenor EVD ( CADalone group [reference]). Results The cumulative incidenceof major adverse cardiovascular events ( MACE: composite of cardiovascular death, myocardial infarction and stroke) through 3 years was significantly higher in patients with polyvascular disease compared with reference patients (19.9% in the stroke+ CADgroup, 18.5% in the EVD + CADgroup, 20.1% in the stroke/EVD/ CADgroup, and 11.2% in the CADalone group, P P P P = 0.0007 in the stroke/EVD/ CADgroup). However, the presence of EVD and/or strokewas not associated with higher risk for myocardial infarction. Conclusions Clinical outcome after coronary revascularizationwas worse in patients with prior strokeand/or EVD, which was mainly driven by the increased risk for non-coronary cardiovascular events.