RESEARCH ARTICLE
Effects of upper-extremity vascular access creation on cardiac events in patients undergoing coronary artery bypass grafting Youngjin Han1, Suk Jung Choo2, Hyunwook Kwon1, Jae Won Lee2, Cheol Hyun Chung2, Hyangkyoung Kim3, Tae-Won Kwon1, Yong-Pil Cho1* 1 Department of and Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea, 2 Department of Thoracic Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea, 3 Department of Surgery, Chung-Ang University Hospital, Seoul, South Korea *
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OPEN ACCESS Citation: Han Y, Choo SJ, Kwon H, Lee JW, Chung CH, Kim H, et al. (2017) Effects of upper-extremity vascular access creation on cardiac events in patients undergoing coronary artery bypass grafting. PLoS ONE 12(9): e0184168. https://doi. org/10.1371/journal.pone.0184168 Editor: Cesario Bianchi, Universidade de Mogi das Cruzes, BRAZIL Received: April 20, 2017 Accepted: August 18, 2017 Published: September 5, 2017 Copyright: © 2017 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist.
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; P15) (diastolic heart failure) [12–14]. Follow-up data were obtained from hospital charts or follow-up physicians, and by means of direct telephone interviews with the patients or their families. Only the first event of each outcome was included in the analysis. Follow-up ceased with the occurrence of MACE or late death from any cause or termination of VA. Demographics, risk factors of interest, and other data were recorded for each patient. Prior cerebrovascular accidents (CVAs) were defined as a history of focal cerebral ischemia or hemorrhage; however, there was no hemorrhagic CVA in our analysis. Prior peripheral arterial occlusive disease (PAOD) was defined as radiological/surgical interventions for PAOD or an ankle brachial index of 0.9 as measured with Doppler ultrasound [15]. All data were collected, for all consecutive patients, in an Excel database (Microsoft Corp., Redmond, WA, USA), and the study outcomes and associated clinical variables were retrospectively analyzed.
Statistical analysis Categorical variables are reported as frequencies or percentages, and continuous variables as means and standard deviations. Categorical variables were compared for differences between the two groups by using chi-square test or Fisher’s exact test where appropriate, and continuous variables were compared for differences by using the Mann–Whitney U-test. Univariate and multivariate analyses of the association of clinical variables with the study outcomes were conducted with Cox proportional hazards modeling, by using the event of interest and period from study enrollment to the date of the event or last follow-up as the outcome. Univariate Cox proportional hazard regression models were fitted to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) to estimate the association of clinical variables with the occurrence of primary or secondary outcome. Variables with a P-value of
