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Selective screening for coronary artery disease in patients undergoing elective repair of abdominal aortic aneurysms
W D Suggs1, R B Smith, W S Weintraub
1Department of Surgery, Emory University, School of Medicine, Atlanta.
Insights
Preoperative screening for coronary artery disease effectively identifies patients needing intervention before abdominal aortic aneurysm repair, leading to low cardiac complication rates. This approach ensures safer surgical outcomes for high-risk patients.
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Abdominal aortic aneurysm (AAA) repair is associated with significant cardiac risks.
- Preoperative assessment of coronary artery disease (CAD) is crucial for risk stratification before major vascular surgery.
- Identifying and managing CAD can reduce perioperative cardiac events.
Purpose of the Study:
- To retrospectively evaluate the effectiveness of CAD screening prior to elective AAA repair.
- To assess the impact of preoperative cardiac evaluation on perioperative outcomes.
- To determine the utility of selective coronary revascularization in patients undergoing AAA repair.
Main Methods:
- Analysis of a screening algorithm for CAD in 263 patients undergoing elective AAA repair (1986-1989).
- Utilized dipyridamole-thallium scintigraphy and cardiac catheterization for patients with CAD indicators.
- Exempted patients with recent coronary revascularization or angina from further screening unless clinically indicated.
Main Results:
- 13 of 263 AAA repairs were cancelled due to cardiac concerns.
- A total cardiac complication rate of 2.4% (3 perioperative deaths, 3 nonfatal myocardial infarctions) was observed among 247 performed AAA repairs.
- Selective coronary revascularization was performed in 22 patients prior to AAA repair.
Conclusions:
- Preoperative screening for CAD and selective coronary revascularization are effective strategies.
- This approach is associated with a low rate of cardiac complications during elective AAA repair.
- Optimized cardiac management improves surgical outcomes in patients with AAA.
Purpose:
The purpose of this study was to retrospectively evaluate the effectiveness of screening for coronary artery disease before elective repair of abdominal aortic aneurysms (AAA) was performed.
Methods:
Results of a screening algorithm for coronary artery disease in 263 patients admitted to a single hospital for elective repair of AAA between January 1986 and December 1989 were analyzed. Patients with no coronary artery disease indicators proceeded to surgery without further workup. Patients with cardiac disease indicators underwent dipyridamole-thallium scintigraphy, and patients with angina were screened by use of cardiac catheterization; those with a recent coronary revascularization underwent no additional screening unless symptoms or electrocardiographic changes suggested an intervening event. Twenty-eight patients underwent no screen other than medical history and electrocardiogram.
Results:
Among 164 patients screened with dipyridamole-thallium scintigraphy, 44 patients had redistribution defects that required catheterization, and 11 of these underwent coronary revascularization. Cardiac catheterization was performed directly in 42 patients, which led to 11 revascularizations before AAA repair. Previous coronary artery bypass or percutaneous transluminal angioplasty obviated additional screening in 29 patients. Of the 263 scheduled AAA repairs, 15 were cancelled because of unacceptable operative risks, 13 for cardiac reasons. One patient died of a ruptured AAA after an uneventful coronary artery bypass. Among the 247 AAA repairs performed, there were three perioperative deaths (1.2%), all of which resulted from sudden cardiac events; three additional patients had nonfatal myocardial infarctions (1.2%), for a total cardiac complication rate of 2.4%.
Conclusions:
The low rate of cardiac complications in this experience affirms the effectiveness of preoperative screening and selective coronary revascularization before AAA repair.