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Abdominal aortic aneurysms and coronary artery disease: is a more aggressive approach indicated?
Insights
Patients with known ischemic heart disease undergoing elective abdominal aortic aneurysm repair had similar survival rates and myocardial infarction incidence compared to those without heart disease. Pre-operative management of coronary artery disease does not require a more aggressive approach.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Clinical Cardiology
Background:
- Elective repair of abdominal aortic aneurysms (AAA) is a common surgical procedure.
- Ischemic heart disease (IHD) is a significant comorbidity in patients undergoing AAA repair.
- The impact of pre-existing IHD on surgical outcomes requires careful evaluation.
Purpose of the Study:
- To assess the influence of known IHD on operative and long-term survival after elective AAA repair.
- To compare the incidence of myocardial infarction (MI) between patients with and without IHD.
- To determine if a more aggressive pre-operative approach to coronary artery disease is warranted.
Main Methods:
- Retrospective study of 171 patients undergoing elective AAA repair between June 1977 and December 1983.
- Patients were divided into cardiac (history of heart disease and/or abnormal ECG) and noncardiac groups.
- Outcomes including operative mortality, MI incidence, and long-term survival were analyzed.
Main Results:
- No significant difference in operative mortality or MI incidence between cardiac and noncardiac groups.
- Overall 1-year survival was 95% and 5-year survival was 76%.
- 1-year survival was 97% (cardiac) vs 95% (noncardiac), and 5-year survival was 72% (cardiac) vs 79% (noncardiac).
Conclusions:
- Known IHD did not significantly impact operative or long-term survival after elective AAA repair.
- The incidence of MI was similar in both groups.
- This study does not support a more aggressive pre-operative management of coronary artery disease in AAA patients.
Abstract:
A retrospective study was undertaken to assess the influence of known ischaemic heart disease on the operative and the long-term survival of patients undergoing elective repair of an abdominal aortic aneurysm. One hundred and seventy-one patients underwent elective surgery between June 1977 and December 1983. The patients were divided on routine clinical grounds into cardiac and noncardiac groups. Ninety-five patients had a history of heart disease and/or an abnormal resting pre-operative ECG. Seventy-six patients had no history of heart disease and a normal pre-operative resting ECG. Two of the seven operative deaths were due to myocardial infarction with one each from the cardiac and noncardiac groups. Eight patients suffered an acute myocardial infarction with five from the cardiac and three from the noncardiac group and this was not significantly different. The overall survival of 95% at 1 year and 76% at 5 years closely follows the age/sex matched Australian population. The survival at 1 year in the cardiac group was 97% and 95% in the noncardiac group. The 5 year survival was 72% and 79% respectively. During follow-up to December 1984, 11 patients died from ischaemic heart disease with six from the cardiac and five from the noncardiac group. No significant difference was found between the two groups in the incidence of myocardial infarction or the short- and long-term survival. This study does not support a more aggressive approach to coronary artery disease in the pre-operative management of patients with abdominal aortic aneurysm.