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Effects of upper-extremity vascular access creation on cardiac events in patients undergoing coronary artery bypass
Youngjin Han1, Suk Jung Choo2, Hyunwook Kwon1
1Department of and Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
Insights
Creating upper-extremity vascular access (VA) before coronary artery bypass grafting (CABG) with a left internal thoracic artery (ITA) graft does not increase major adverse cardiac events (MACE) or death. However, the type of VA, specifically prosthetic arteriovenous grafting, is a significant predictor of MACE or death.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) with a left internal thoracic artery (ITA) graft is a standard procedure.
- Upper-extremity vascular access (VA) is frequently created in patients undergoing CABG.
- The potential impact of VA creation on cardiac outcomes in this specific patient population remains unclear.
Purpose of the Study:
- To investigate whether upper-extremity VA creation increases the risk of major adverse cardiac events (MACE) and death in patients undergoing CABG with an in situ left ITA graft.
- To determine if the side (ipsilateral vs. contralateral) or type of VA influences these outcomes.
Main Methods:
- Retrospective analysis of 111 patients who underwent CABG with a left ITA graft and subsequent upper-extremity VA creation.
- Patients were categorized into ipsilateral (left-sided VA) and contralateral (right-sided VA) groups.
- Outcomes assessed included MACE and the composite of MACE or late death, analyzed using multivariate regression.
Main Results:
- No significant difference in MACE or MACE/late death was observed between ipsilateral and contralateral VA groups.
- Prior cerebrovascular accidents and VA type were independently associated with MACE.
- Prior peripheral arterial occlusive disease and prosthetic arteriovenous grafting were associated with MACE or death.
Conclusions:
- Ipsilateral upper-extremity VA creation does not appear to increase the risk of MACE or late death in patients undergoing CABG with a left ITA graft.
- The type of VA, particularly prosthetic arteriovenous grafting, is a significant predictor of adverse cardiac events and mortality.
- Further research may be warranted to explore the implications of different VA types in this patient cohort.
Abstract:
The present study was conducted to investigate whether upper-extremity vascular access (VA) creation increases the risk for major adverse cardiac events (MACE) and death in patients undergoing coronary artery bypass grafting (CABG) with an in situ left internal thoracic artery (ITA) graft. A total of 111 patients with CABG with a left ITA graft who underwent upper-extremity VA creation were analyzed retrospectively; 93 patients received left VA creation (83.8%, ipsilateral group) and 18 patients received right VA creation (16.2%, contralateral group). The primary outcome was the occurrence of MACE, and the secondary outcome was the composite of MACE or late death. There were no significant differences in the incidence of primary (P = 0.30) or secondary (P = 0.09) outcomes between the two groups. Multivariate regression analysis indicated that prior cerebrovascular accidents (hazard ratio [HR] 3.30; 95% confidence interval [CI] 1.37-7.97; P = 0.01) and type of VA (HR 3.44; 95% CI 1.34-8.82; P = 0.01) were independently associated with MACE; prior peripheral arterial occlusive disease (HR 4.22; 95% CI 1.62-10.98; P<0.01) and type of VA (arteriovenous fistula vs. prosthetic arteriovenous grafting) (HR 3.06; 95% CI, 1.42-6.61; P<0.01) were associated with the composite of MACE or death. The side and location of VA were not associated with MACE or death. Our study showed no definite evidence that ipsilateral VA creation affects the subsequent occurrence of MACE or late death from any cause. The type of VA (a prosthetic arteriovenous grafting) is a significant predictor of the subsequent occurrence of MACE or late death.