title: Cardiac catheterization in patients with ascending aortic aneurysms: safety, success, and prevalence of coronary artery disease.
abstract: BACKGROUND
  Evaluation for coronary artery disease (CAD) is recommended prior to surgery for ascending aortic aneurysms. Concerns regarding the use of coronary angiography in this population include safety and the ability to successfully selectively engage the coronary arteries. Additionally, the prevalence of CAD is not well described.
  
  
  METHODS
  We retrospectively reviewed all patients referred for cardiac catheterization prior to elective surgery for an ascending aortic aneurysm at our institution over a 4-year period. Catheter selection was based on knowledge of the aneurysm size. Images were screened for whether selective coronary engagement was achieved and for the presence of significant coronary disease.
  
  
  RESULTS
  A total of 205 patients met the inclusion criteria. The mean age was 61 years and 63% were male. There were no adverse events related to catheterization. The left coronary artery was selectively engaged in 98% of patients, and the right coronary in 92%. On average, 3.1 catheters were used for angiography per patient. Coronary artery disease was present in 19% of patients (n = 39). Increasing age was the only risk factor significantly associated with the presence of disease. Coronary bypass was required in 15% of patients at the time of aortic aneurysm surgery.
  
  
  CONCLUSIONS
  Coronary angiography can be performed safely and the coronary arteries can be successfully selectively engaged in patients with ascending aortic aneurysms. The findings frequently impact the surgical approach. We believe that coronary angiography should be part of the routine preoperative evaluation in appropriate patients.
authors.affiliation: Division of Cardiology, Virginia Commonwealth University Medical Center, 1200 East Broad St, West Hospital, 5th Floor, West Wing, Room 529-B, Richmond, VA 23298 USA. zgertz@mcvh-vcu.edu.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Gertz
authors.forename: Scott A
authors.initials: SA
authors.lastname: Levitt
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Epps
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: G William
authors.initials: GW
authors.lastname: Moser
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Kolansky
mesh_terms: D000368:Aged; D001011:Aorta; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D015331:Cohort Studies; D017023:Coronary Angiography / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors