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[Coronary artery disease in patients with abdominal aortic aneurysm]
Y Fukumura1, Y Kataoka, Y Nakai
1Department of Cardiology, Komatsushima Red Cross Hospital.
Insights
Coronary artery disease (CAD) is common in patients with abdominal aortic aneurysm (AAA), even without symptoms. Routine coronary angiography before AAA surgery is recommended to prevent heart attacks.
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Abdominal aortic aneurysm (AAA) patients often have coexisting coronary artery disease (CAD).
- Prevalence and impact of CAD in AAA patients require further investigation.
Purpose of the Study:
- To determine the prevalence of CAD in patients undergoing evaluation for AAA.
- To assess the utility of routine coronary angiography in this patient group.
Main Methods:
- Selective coronary angiography was performed in 30 patients with AAA.
- Risk factors, symptoms, ECG, and angiographic findings were analyzed.
- Coronary angiography was performed pre-operatively in 22 patients.
Main Results:
- Significant coronary artery stenosis was found in 68.2% of patients who underwent pre-operative angiography.
- CAD was prevalent even in asymptomatic patients and those under 65.
- 9 patients underwent myocardial revascularization (4 CABG, 5 PTCA).
Conclusions:
- Coronary artery disease is frequently present in patients with abdominal aortic aneurysm.
- Routine coronary angiography is recommended for AAA patients to prevent myocardial infarction.
- Myocardial revascularization should be considered before aneurysmectomy if significant CAD is detected.
Abstract:
Selective coronary angiography to determine the prevalence of coronary artery disease (CAD) has been performed in patients with abdominal aortic aneurysm (AAA). Thirty patients in this series consisted of 26 men and 4 women with an age range of 48-87 years (mean +/- SD: 67.5 +/- 8.2 years). As the atherosclerotic risk factors, cigarette smoking was present in 19 patients (63.3%), hypertension was in 18 (60%), hypercholesteremia was in 10 (33.3%), and diabetes mellitus was in 2 (6.7%). Cerebral vascular disease was present in 11 patients (36.7%). Regarding CAD, angina pectoris or old myocardial infarction was found in 9 patients (30%), and abnormal electrocardiography (ECG) was in 16 patients (53.3%). Coronary angiography prior to operation of AAA was performed to 22 patients (73.3%), and 15 patients (68.2%) among them had significant coronary artery stenosis, and 9 patients underwent myocardial revascularization (4 CABG, 5 PTCA). CAD was frequently complicated both in patients without symptoms or ECG abnormalities and in less than 65-year patients. In order to prevent fatal myocardial infarction, we recommend routine coronary angiography to patients with AAA. And if necessary, myocardial revascularization must be indicated prior to aneurysmectomy.