Coronary Artery Disease and Preoperative Coronary Angiography in Elective Thoracic Endovascular Aortic Repair: A

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Published on: March 26, 2018

Marwan Hamiko1, Lamis Keswani2, Ali Bayram1

  • 1Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.

Journal of Cardiovascular Development and Disease
|June 25, 2026
PubMed

Insights

Routine preoperative coronary angiography (CAG) for thoracic endovascular aortic repair (TEVAR) candidates identifies significant coronary artery disease (CAD) without impacting short-term outcomes. While CAD patients have higher unadjusted mortality, this is explained by systemic atherosclerosis, suggesting routine assessment is justified.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Coronary artery disease (CAD) often coexists with thoracic aortic disease, potentially increasing risks after thoracic endovascular aortic repair (TEVAR).
  • The benefit of routine preoperative coronary angiography (CAG) in patients undergoing elective TEVAR remains uncertain.
  • Evaluating the impact of preoperative CAG on outcomes in TEVAR patients is crucial for optimizing perioperative care.

Purpose of the Study:

  • To investigate whether routine preoperative coronary angiography (CAG) improves outcomes in patients undergoing elective thoracic endovascular aortic repair (TEVAR).
  • To assess the prevalence and impact of coronary artery disease (CAD) in patients undergoing TEVAR.
  • To determine the association between preoperative coronary revascularization and long-term survival in TEVAR patients with CAD.

Main Methods:

  • Retrospective analysis of 177 patients undergoing elective TEVAR from 2015-2025 with a median follow-up of 4.9 years.
  • Comparison of outcomes between patients who underwent preoperative CAG versus those who did not.
  • Analysis of survival using Kaplan-Meier and overlap-weighted Cox regression, comparing patients with and without CAD.

Main Results:

  • Preoperative CAG was performed in 53.1% of patients, identifying significant CAD in 44.7% of those assessed.
  • No significant differences in in-hospital mortality or major adverse cardiovascular events were observed between patients who underwent CAG and those who did not.
  • While CAD patients had higher unadjusted mortality, this association was attenuated after adjustment for comorbidities, and preoperative revascularization did not improve survival.

Conclusions:

  • Preoperative CAG identifies clinically relevant CAD in a substantial proportion of TEVAR candidates, enabling timely revascularization.
  • Outcomes were comparable between patients who underwent CAG and those who did not, irrespective of CAD burden.
  • The long-term survival disadvantage associated with CAD appears largely attributable to systemic atherosclerosis, supporting the justification for routine preoperative coronary assessment in elective TEVAR.

Keywords:
coronary angiographycoronary artery diseasethoracic endovascular aortic repair

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