title: Usefulness of revascularization of patients with multivessel coronary artery disease before elective vascular surgery for abdominal aortic and peripheral occlusive disease.
abstract: The Coronary Artery Revascularization Prophylaxis (CARP) study showed no survival benefit with preoperative coronary artery revascularization before elective vascular surgery. The generalizability of the trial results to all patients with multivessel coronary artery disease (CAD) has been questioned. The objective of this study was to determine the impact of prophylactic coronary revascularization on long-term survival in patients with multivessel CAD. Over a 4-year period, 1,048 patients underwent coronary angiography before vascular surgery during screening into the CARP trial. The cohort was composed of registry (n = 586) and randomized (n = 462) patients, and their survival was determined at 2.5 years after vascular surgery. High-risk coronary anatomy without previous bypass surgery included 2-vessel disease (n = 204 [19.5%]), 3-vessel disease (n = 130 [12.4%]), and left main coronary artery stenosis > or = 50% (n = 48 [4.6%]). By log-rank test, preoperative revascularization was associated with improved survival in patients with a left main coronary artery stenoses (0.84 vs 0.52, p <0.01) but not those with either 2-vessel (0.80 vs 0.79, p = 0.83) or 3-vessel (0.79 vs 0.71, p = 0.15) disease. In conclusion, unprotected left main coronary artery disease was present in 4.6% of patients who underwent coronary angiography before vascular surgery, and this was the only subset of patients showing a benefit with preoperative coronary artery revascularization.
authors.affiliation: Cardiology Section, Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Moritz
authors.forename: Herbert B
authors.initials: HB
authors.lastname: Ward
authors.forename: Gordon
authors.initials: G
authors.lastname: Pierpont
authors.forename: Steve
authors.initials: S
authors.lastname: Goldman
authors.forename: Greg C
authors.initials: GC
authors.lastname: Larsen
authors.forename: Fred
authors.initials: F
authors.lastname: Littooy
authors.forename: William
authors.initials: W
authors.lastname: Krupski
authors.forename: Lizy
authors.initials: L
authors.lastname: Thottapurathu
authors.forename: Domenic J
authors.initials: DJ
authors.lastname: Reda
authors.forename: Edward O
authors.initials: EO
authors.lastname: McFalls
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000601:surgery*; D016016:Proportional Hazards Models; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome