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Coronary risk in candidates for abdominal aortic aneurysm repair: a word of caution

Raoul Borioni1, Fabrizio Tomai, Alessio Pederzoli

  • 1aDepartment of Vascular Surgery, Aurelia Hospital bDepartment of Cardiovascular Sciences, European Hospital, Rome, Italy.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|September 25, 2014
PubMed

Insights

Low-risk patients undergoing abdominal aortic aneurysm (AAA) repair often have significant coronary artery disease (CAD). Preoperative coronary angiography and revascularization may be beneficial for these patients.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Current guidelines do not mandate routine coronary evaluation for low-risk abdominal aortic aneurysm (AAA) repair candidates.
  • The Revised Cardiac Risk (Lee) Index (RCRI) < 2 typically excludes patients from preoperative cardiac assessment.
  • This study investigates coronary lesions in such low-risk AAA patients.

Purpose of the Study:

  • To determine the incidence of coronary artery disease (CAD) in patients with an RCRI < 2 undergoing AAA repair.
  • To report the early-term and long-term outcomes of prophylactic myocardial revascularization in this cohort.
  • To evaluate the safety and efficacy of coronary revascularization prior to AAA repair.

Main Methods:

  • Retrospective observational cohort study of 149 consecutive patients.
  • Patients underwent preoperative coronary angiography and myocardial revascularization (PCI or CABG) before elective AAA repair.
  • Data collected from January 2005 to December 2012.

Main Results:

  • Severe CAD was identified in 43 patients (28.9%), successfully treated with PCI (35) or off-pump CABG (8).
  • Approximately 25% of low-risk patients and 29.8% of asymptomatic patients had severe CAD.
  • AAA repair (endovascular or open) had low morbidity (0.6%) and mortality (0.6%). Long-term survival was high.

Conclusions:

  • The incidence of severe, correctable CAD is significant in low-risk AAA repair candidates.
  • Consideration for broader indications of coronary angiography and revascularization is warranted.
  • Further large-scale studies are needed to refine guidelines for cardiac evaluation in vascular patients.
Abstract

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