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Original Articles

Vascular Disease Burden and In-Hospital Outcomes Among Patients Undergoing Percutaneous Coronary Intervention in New York State

Jeffrey S. Berger, MD, MS; John L. Petersen, MD and David L. Brown, MD, FAHA

From the Division of Cardiovascular Medicine, Department of Medicine (J.S.B., J.L.P.), Duke University Medical Center, Durham, NC; Division of Cardiovascular Medicine, Department of Medicine (J.S.B.), University of Pennsylvania, Philadelphia, Pa; and Division of Cardiovascular Medicine, Department of Medicine (D.L.B.), Stony Brook University Medical Center, Stony Brook, NY.

Correspondence to David L. Brown, MD, Division of Cardiovascular Medicine, Stony Brook University, Health Sciences Center T 16-080, Stony Brook, NY 11794-8171. E-mail david.brown{at}stonybrook.edu

Received December 29, 2008; accepted June 19, 2009.

Background— The presence of atherosclerosis in extracardiac vascular beds is associated with an increased risk of adverse cardiovascular outcomes among stable patients with coronary artery disease (CAD). However, there is little data regarding the impact of the presence and extent of vascular disease on outcomes in patients with CAD undergoing percutaneous coronary intervention.

Methods and Results— We analyzed 69 045 consecutive patients from the New York State Coronary Angioplasty Reporting System database who underwent percutaneous coronary intervention between 1998 and 1999. Vascular disease burden was assessed by history of aortoiliac, femoral-popliteal, and carotid disease. Patients were stratified into 3 groups: CAD alone, CAD and 1 additional site, and CAD and 2 or 3 additional sites. A logistic regression model was constructed to determine the relation between vascular disease burden and in-hospital mortality. Any history of vascular disease was present in 5915 (8.6%) of the population, of whom 4840 (82%) had CAD and 1 other disease location and 1075 (18%) had CAD and 2 or 3 other disease locations. There was a significant relationship between the number of disease locations and hospital mortality, ranging from 0.7% in patients with CAD alone to 2.0% and 2.6% for patients with 1 or 2 disease locations, respectively (P<0.001). In unadjusted analysis, in-hospital mortality was 3-fold higher (odds ratio, 2.89; 95% CI, 2.31 to 3.60; P<0.001) and 4-fold higher (odds ratio, 3.78; 95% CI, 2.57 to 5.56; P<0.001) for inpatients with CAD and additional vascular disease at 1 site and 2 sites, respectively. After multivariable adjustment, each additional vascular bed affected was associated with a 50% increase in in-hospital mortality (odds ratio, 1.50; 95% CI, 1.27 to 1.78; P<0.001).

Conclusions— Among patients with CAD undergoing percutaneous coronary intervention, vascular disease burden is associated with higher rates of adverse events and is an independent predictor of in-hospital mortality.

Key Words: peripheral vascular disease • coronary disease • mortality

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CLINICAL PERSPECTIVE

The conclusions expressed herein do not represent those of the New York State Department of Health or its Cardiac Advisory Committee.