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Related Experiment Video

Updated: May 11, 2026

Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats

Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats

Published on: June 28, 2019

Coronary-artery revascularization before elective major vascular surgery.

Edward O McFalls¹, Herbert B Ward, Thomas E Moritz

¹Minneapolis Veterans Affairs Medical Center, Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis 55417, USA. mcfal001@tc.umn.edu

The New England Journal of Medicine

|December 31, 2004

Summary

Coronary-artery revascularization before major vascular surgery did not significantly improve long-term survival. This study suggests that routine revascularization is not recommended for patients with stable cardiac symptoms undergoing such procedures.

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Published on: September 15, 2023

Area of Science:

Cardiology
Vascular Surgery
Clinical Trials

Background:

The clinical benefit of revascularizing coronary arteries prior to elective major vascular surgery remains uncertain.
Patients undergoing vascular surgery often have underlying coronary artery disease, increasing perioperative cardiac risk.

Purpose of the Study:

To determine if preoperative coronary-artery revascularization impacts long-term mortality in patients undergoing elective major vascular surgery.
To assess the effect of revascularization on perioperative myocardial infarction.

Main Methods:

A randomized trial involving 510 high-risk patients with coronary artery disease undergoing major vascular surgery.
Patients were assigned to either undergo coronary-artery revascularization or no revascularization before their scheduled vascular operation.
The primary outcome was long-term mortality, with secondary outcomes including perioperative myocardial infarction.

Main Results:

After a median follow-up of 2.7 years, long-term mortality was similar between the revascularization group (22%) and the no-revascularization group (23%) (P=0.92).
There was no significant difference in the rate of postoperative myocardial infarction within 30 days between the two groups (12% vs. 14%, P=0.37).
Indications for vascular surgery included abdominal aortic aneurysms and peripheral arterial occlusive disease.

Conclusions:

Coronary-artery revascularization before elective vascular surgery does not significantly alter long-term outcomes.
A strategy of routine coronary-artery revascularization is not recommended for patients with stable cardiac symptoms undergoing elective vascular surgery based on these findings.