title: Cardiac investigation and intervention prior to thoraco-abdominal aneurysm repair: coronary angiography in 35 patients.
abstract: OBJECTIVE
  retrospective studies indicate a high risk of cardiac events in patients undergoing thoraco-abdominal aneurysm repair. We aimed to determine the prevalence of coronary disease in these patients, define the role of non-invasive cardiac testing and assess the short-term outcome of coronary re-vascularisation.
  
  
  METHODS
  a prospective cohort study of consecutive patients referred to a single surgeon.
  
  
  METHODS
  forty patients recruited over 16 months (Type I, 6; II, 11; III, 8; IV, 15). Dobutamine stress echocardiography, coronary angiography and coronary re-vascularisation (PTCA or CABG) were performed according to a pragmatic protocol. Main outcome measures were the prevalence of coronary artery disease, sensitivity and specificity of clinical assessment and non-invasive cardiac testing, and adverse events associated with coronary investigation and intervention.
  
  
  RESULTS
  seven patients (17.5%) were stratified as having high perioperative cardiac risk. The majority of patients (23, 57.5%) had no cardiac risk factor other than the operation type. Five patients (12.5%) had inducible ischaemia on non-invasive testing. Fourteen patients (40%) had haemodynamically significant coronary artery stenoses, of whom 12 (34%) underwent coronary revascularisation. Dobutamine stress echocardiography demonstrated 100% specificity and 71% sensitivity for the detection of significant coronary artery lesions. Coronary re-vascularisation by three-vessel bypass grafting was complicated by non-fatal stroke in one patient. Thirty-five patients (87.5%) proceeded to aneurysm repair. No patient who had been adequately investigated suffered a cardiac complication.
  
  
  CONCLUSIONS
  the 40% prevalence of coronary artery disease in these patients is comparable to that of other patients undergoing arterial surgery. Non-invasive testing proved beneficial, both in screening low-risk patients and planning intervention in patients at higher risk. An aggressive approach to intervention was associated with an acceptable complication rate and favourable short-term outcome.
authors.affiliation: Regional Vascular Unit, St Mary's Hospital, London, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Brooks
authors.forename: J
authors.initials: J
authors.lastname: Mayet
authors.forename: B
authors.initials: B
authors.lastname: Glenville
authors.forename: R
authors.initials: R
authors.lastname: Foale
authors.forename: J H
authors.initials: JH
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D004280:Dobutamine; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D004280:Dobutamine