Management of coronary artery disease in patients undergoing elective abdominal aortic aneurysm open repair.
BACKGROUND
The efficacy of prophylactic coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in patients with abdominal aortic aneurysm (AAA) scheduled for open repair surgery remains controversial.


OBJECTIVE
Concomitant coronary artery disease (CAD) with no inducible ischemia can be medically treated in AAA patients undergoing open repair as long as the existence of CAD is recognized.


METHODS
A retrospective analysis of acute and long-term outcomes was performed for 122 patients with AAA who underwent coronary arteriography (CAG) for preoperative evaluation followed by elective open repair.


RESULTS
Preoperative CAG revealed no CAD in 54 patients (non-CAD group) and the existence of CAD in 68 patients. Prophylactic PCI or CABG surgery was performed in 16 patients (CAD-PCI/CABG group) with symptomatic angina, ischemia proven by pharmacological stress scintigraphy, or coexistence of reduced cardiac contraction and coronary stenosis in multiple vessels. Medical treatment was administered to 52 patients who had no signs of ischemia (CAD-medical group). During the perioperative period, no cardiac event occurred irrespective of the existence of CAD. The long-term outcomes in the CAD-medical group were equivalent to those in the non-CAD group. In the CAD-PCI/CABG group, the cardiac event-free rate was comparable with that of other groups, although mortality was higher.


CONCLUSIONS
In patients undergoing AAA open repair, medical treatment for concomitant CAD with no obvious inducible ischemia does not confer unfavorable outcomes. Although prophylactic coronary revascularization possibly prevents future cardiac events, it appears to be necessary in a very limited number of cases.
Hosokawa
Yusuke
Y
Department of Cardiovascular Medicine, Shizuoka Medical Center, Shizuoka, Japan.
Takano
Hitoshi
H
Aoki
Asako
A
Inami
Toru
T
Ogano
Michio
M
Kobayashi
Nobuaki
N
Tanabe
Jun
J
Yokoyama
Hiroyuki
H
Kato
Takayoshi
T
Takagi
Hisato
H
Umemoto
Takuya
T
Takayama
Morimasa
M
Mizuno
Kyoichi
K
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged