Coronary artery revascularization before abdominal aortic aneurysm surgery: a decision analytic approach

Decision analysis is a method for quantitatively comparing the risks and benefits of diagnostic and therapeutic procedures, and for determining the influence of variation in a priori probabilities assigned to different outcomes. Therefore, we have constructed a decision tree to determine outcome probabilities between performing abdominal aortic surgery alone or to perform preoperative testing which may lead to coronary revascularization before noncardiac surgery. Sensitivity analyses were performed in which the assigned probabilities, obtained from the literature, were varied within a reported range to determine its influence on the optimal decision pathway. The optimal decision whether to perform preoperative testing and coronary revascularization prior to abdominal aortic reconstruction is dependent on both the mortality associated with coronary revascularization and the mortality of the surgical procedure performed without preoperative interventions. Within the range of mortality reported in the literature, strategies of either selective preoperative testing or no preoperative testing can be justified.