The Prognostic Impact of Polyvascular Disease on Long-term Outcomes in Patients with Coronary Artery Disease

Background: Involvement of atherosclerosis in extracardiac vascular territories may identify coronary artery disease (CAD) patients at higher risk for adverse events. We investigated the long-term prognostic implications of polyvascular disease in patients with CAD, and further analyzed lipid goal attainment and its relation to outcome.

Methods: Retrospective analysis of 10,297 patients undergoing coronary revascularization between 2000-2015 in a single center. Patients were categorized as having CAD alone (83.1%) or multisite artery disease (16.9%) including cerebrovascular disease (CBVD) and/or peripheral artery disease (PAD). Incidence rates and hazard ratios (HR) for 10-year MACE (myocardial infarction, ischemic stroke or all-cause death) according to the vascular territories involved, and in relation to most-recent lipid levels attained, were analyzed.

Results: Patients with multisite artery disease had higher rates of comorbidities, particularly diabetes (54% vs. 35%), hypertension (84% vs. 69%) and reduced glomerular filtration rate (37% vs. 20%), than those with CAD alone. The rates of MACE and its individual components increased with the number of affected vascular beds. Adjusted HR for MACE was 1.41 (1.24-1.59) in patients with CAD and CBVD, 1.46 (1.33-1.62) in CAD and PAD and 1.69 (1.49-1.92) in those with CAD and CBVD and PAD, compared to CAD alone. Most-recent LDL cholesterol (LDL-C) levels <55mg/dL and <70mg/dL were attained by 21.8% and 44.6% of patients with CAD alone, in comparison to 22.7% and 43.3% in multisite artery disease. Compared to patients with most-recent LDL-C>100mg/dL (Ref.), CAD only patients attaining LDL-C<70mg/dL had an adjusted HR of 0.63 (0.57-0.70) and multisite artery disease patients 0.69 (0.59-0.81) for death.

Conclusions: Presence of CBVD and/or PAD is associated with increased burden of comorbidities and long-term MACE in patients with CAD. More than half of the patients with or without multisite artery disease do not achieve lipid goals which are associated with reduced risk for adverse events.

Cumulative Incidence of 10-year MACE, according to Vascular Teritories Involved