title: Coronary risk in candidates for abdominal aortic aneurysm repair: a word of caution.
abstract: BACKGROUND
  Current guidelines do not recommend routine coronary evaluation preceding abdominal aortic aneurysms (AAA) repair in low-risk patients. The purpose of the present study is to report the incidence of coronary lesions in candidates for AAA repair with a Revised Cardiac Risk (Lee) Index (RCRI) < 2, which are usually excluded from preoperative cardiological work-up. Early-term and long-term results of prophylactic myocardial revascularization are also reported.
  
  
  METHODS
  A retrospective, observational, cohort study collecting clinical data on a series of 149 consecutive patients undergoing preoperative coronary angiography and myocardial revascularization (percutaneous coronary intervention, PCI; coronary artery bypass grafting, CABG) before elective open or endovascular AAA repair (January 2005-December 2012).
  
  
  RESULTS
  Severe coronary artery disease (CAD) was revealed in 43 patients (28.9%), who underwent successful myocardial revascularization by means of PCI (n.35) or off-pump CABG (n.8). The incidence of severe CAD in patients resulted at low risk on the basis of risk models was approximately 25%. The incidence of severe CAD in asymptomatic patients was 29.8%. Endovascular (n.52, 35.1%) and open (n.96, 64.9%) AAA repair was performed with low morbidity (0.6%) and mortality (0.6%) in 148 patients. The long-term estimated survival (freedom from fatal cardiovascular events) was 97% at 60 months and 82% at 90 months.
  
  
  CONCLUSIONS
  The incidence of severe correctable CAD is not negligible in low-risk patients scheduled for AAA repair. Waiting for further recommendations based on large population studies of vascular patients, a more extensive indication to coronary angiography and revascularization should be considered in many candidates for AAA repair.
authors.affiliation: aDepartment of Vascular Surgery, Aurelia Hospital bDepartment of Cardiovascular Sciences, European Hospital, Rome, Italy.
authors.forename: Raoul
authors.initials: R
authors.lastname: Borioni
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.forename: Alessio
authors.initials: A
authors.lastname: Pederzoli
authors.forename: Laura
authors.initials: L
authors.lastname: Fratticci
authors.forename: Filippo
authors.initials: F
authors.lastname: Barberi
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.forename: Marzia
authors.initials: M
authors.lastname: Albano
authors.forename: Mariano
authors.initials: M
authors.lastname: Garofalo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000601:surgery; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome