Diagnosis and treatment of ischemia-producing coronary stenoses improves 5-year survival of patients undergoing major...

Area of Science:

• Cardiovascular Medicine
• Radiology
• Vascular Surgery

Background:

• Patients undergoing vascular surgery have high mortality due to undiagnosed coronary artery disease (CAD).
• Asymptomatic (silent) coronary ischemia is a significant risk factor for adverse cardiac events in this population.
• Current guidelines often do not address routine screening for silent ischemia before major vascular surgery.

Purpose of the Study:

• To evaluate if preoperative diagnosis of silent coronary ischemia using FFR-CT combined with postoperative revascularization improves outcomes.
• To assess the impact on major adverse cardiac events and long-term survival following major vascular surgery.

Main Methods:

• Observational cohort study of 522 patients undergoing elective vascular surgery without known CAD.
• FFR-CT guided group (n=288): Preoperative coronary CT angiography (CTA) and FFR-CT for ischemia detection, with selective postoperative revascularization.
• Usual Care group (n=234): Standard preoperative evaluation and best medical therapy (BMT) alone.

Main Results:

• 65% of patients in the FFR-CT group had asymptomatic lesion-specific coronary ischemia.
• At 5-year follow-up, the FFR-CT guided group showed significantly fewer all-cause deaths (16% vs 36%), cardiovascular deaths (4% vs 21%), myocardial infarctions (4% vs 24%), and MACE (20% vs 47%).
• Five-year survival was significantly higher in the FFR-CT guided group (84%) compared to Usual Care (64%).

Conclusions:

• Preoperative FFR-CT diagnosis of silent ischemia followed by targeted revascularization improves outcomes in vascular surgery patients.
• This strategy significantly reduces adverse cardiovascular events and enhances long-term survival compared to standard care.
• FFR-CT guided management represents a valuable approach for optimizing cardiac care in patients undergoing major vascular surgery.