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Long-term outcome of prophylactic coronary revascularization in cardiac high-risk patients undergoing major vascular

Olaf Schouten1, Jan-Peter van Kuijk, Willem-Jan Flu

  • 1Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.

The American Journal of Cardiology
|March 31, 2009
PubMed

Insights

Prophylactic coronary revascularization before major vascular surgery did not improve long-term survival or cardiac events in high-risk patients. Best medical treatment is comparable to revascularization for these outcomes.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Cardiac Surgery

Background:

  • Patients undergoing major vascular surgery often have extensive coronary artery disease.
  • The immediate postoperative outcomes of prophylactic coronary revascularization are not improved.
  • The long-term benefits remain uncertain.

Purpose of the Study:

  • To assess the long-term benefit of prophylactic coronary revascularization in high-risk vascular surgery patients with extensive coronary artery disease.

Main Methods:

  • 1,880 patients scheduled for major vascular surgery were assessed for risk factors.
  • 430 patients with >=3 risk factors underwent cardiac testing (dobutamine echocardiography or nuclear stress imaging).
  • 101 patients with extensive ischemia were randomized to revascularization (n=49) or no revascularization (n=52).

Main Results:

  • After 2.8 years, overall survival was similar: 64% (no revascularization) vs. 61% (revascularization) (HR 1.18, p=0.61).
  • Survival free of death, myocardial infarction, or revascularization was 49% (medical) vs. 42% (revascularization) (HR 1.51, p=0.13).
  • No significant benefit of revascularization on cardiac events was observed in patients surviving the first 30 days (HR 1.35, p=0.36).

Conclusions:

  • Preoperative coronary revascularization in high-risk patients undergoing major vascular surgery does not improve postoperative or long-term outcomes.
  • Best medical treatment appears to be a viable alternative to prophylactic revascularization in this patient population.
  • Further research may be needed to identify specific subgroups that could benefit from revascularization.

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