Usefulness of Revascularization of Patients With Multivessel Coronary Artery Disease Before Elective Vascular Surgery for Abdominal Aortic and Peripheral Occlusive Disease

Santiago Garcia, Thomas E. Moritz, Herbert B. Ward, Gordon Pierpont, Steven Goldman, Greg C. Larsen, Fred Littooy, William Krupski, Lizy Thottapurathu, Domenic J. Reda, Edward O. McFalls

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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 ≥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.

Original languageEnglish (US)
Pages (from-to)809-813
Number of pages5
JournalThe American journal of cardiology
Volume102
Issue number7
DOIs
StatePublished - Oct 1 2008

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Blood Vessels
Coronary Artery Disease
Coronary Vessels
Survival
Coronary Stenosis
Coronary Angiography
Registries
Anatomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Usefulness of Revascularization of Patients With Multivessel Coronary Artery Disease Before Elective Vascular Surgery for Abdominal Aortic and Peripheral Occlusive Disease. / Garcia, Santiago; Moritz, Thomas E.; Ward, Herbert B.; Pierpont, Gordon; Goldman, Steven; Larsen, Greg C.; Littooy, Fred; Krupski, William; Thottapurathu, Lizy; Reda, Domenic J.; McFalls, Edward O.

In: The American journal of cardiology, Vol. 102, No. 7, 01.10.2008, p. 809-813.

Research output: Contribution to journalArticle

Garcia, Santiago ; Moritz, Thomas E. ; Ward, Herbert B. ; Pierpont, Gordon ; Goldman, Steven ; Larsen, Greg C. ; Littooy, Fred ; Krupski, William ; Thottapurathu, Lizy ; Reda, Domenic J. ; McFalls, Edward O. / Usefulness of Revascularization of Patients With Multivessel Coronary Artery Disease Before Elective Vascular Surgery for Abdominal Aortic and Peripheral Occlusive Disease. In: The American journal of cardiology. 2008 ; Vol. 102, No. 7. pp. 809-813.
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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 ≥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.",
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