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Clinical experience with preoperative coronary angiography
Insights
Coronary artery disease (CAD) is a major risk for death after vascular surgery. Preoperative screening with coronary angiography identified severe CAD in 25% of patients, guiding treatment to reduce cardiac events.
Area of Science:
- Cardiology
- Vascular Surgery
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) is a primary cause of mortality following peripheral vascular reconstruction.
- Reducing fatal myocardial infarction is crucial in patients undergoing vascular procedures.
Purpose of the Study:
- To evaluate the utility of preoperative coronary angiography in identifying severe, correctable CAD in patients considered for elective vascular surgery.
- To develop an algorithm for selecting appropriate patients for cardiac screening or angiography.
Main Methods:
- Coronary angiography was performed on 1000 patients undergoing evaluation for elective peripheral vascular procedures.
- Patients were assessed for severe, surgically correctable CAD.
- Clinical cardiac status was analyzed as an indicator for angiography yield.
Main Results:
- Severe, correctable CAD was found in 25% of the total patient cohort.
- Patients with suspected CAD by clinical criteria had a higher detection rate (34%) compared to those without (14%).
- Clinical cardiac status was the most reliable predictor for the diagnostic yield of coronary angiography.
Conclusions:
- Preoperative coronary angiography is valuable for identifying severe CAD in vascular surgery candidates.
- An algorithm based on clinical assessment can effectively guide the selection of patients for cardiac evaluation.
- Combined or preliminary myocardial revascularization can potentially reduce postoperative cardiac mortality.
Abstract:
CAD is the leading cause of postoperative and late death following peripheral vascular reconstruction. In an attempt to reduce the eventual incidence of fatal myocardial infarction, preoperative coronary angiography was obtained in a series of 1000 patients under serious consideration for elective vascular procedures at The Cleveland Clinic. Those patients found to have severe, surgically correctable CAD were advised to undergo myocardial revascularization as a combined or preliminary operation. Severe, correctable CAD was discovered in 25% of the study group, including 34% of patients suspected to have CAD by conventional clinical criteria in comparison to only 14% of those who were not (p = 2.0 X 10(-13) ). Although severe CAD also was more common among men, patients more than 60 years of age, and diabetic patients, the clinical cardiac status was the most reliable indication of the yield of coronary angiography. Coronary artery bypass was performed in 216 patients, and the operative mortality rate for 1292 cardiac and vascular procedures was 2.6%. On the basis of this experience, an algorithm was constructed to select peripheral vascular patients for noninvasive cardiac screening or coronary angiography.