TY - JOUR
T1 - Usefulness of Revascularization of Patients With Multivessel Coronary Artery Disease Before Elective Vascular Surgery for Abdominal Aortic and Peripheral Occlusive Disease
AU - Garcia, Santiago
AU - Moritz, Thomas E.
AU - Ward, Herbert B.
AU - Pierpont, Gordon
AU - Goldman, Steve
AU - Larsen, Greg C.
AU - Littooy, Fred
AU - Krupski, William
AU - Thottapurathu, Lizy
AU - Reda, Domenic J.
AU - McFalls, Edward O.
N1 - Funding Information:
This study was supported by the Cooperative Studies Program of the United States Department of Veterans Affairs, Office of Research and Development, Washington, District of Columbia. Coronary artery disease
PY - 2008/10/1
Y1 - 2008/10/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=52349093644&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=52349093644&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2008.05.022
DO - 10.1016/j.amjcard.2008.05.022
M3 - Article
C2 - 18805102
AN - SCOPUS:52349093644
SN - 0002-9149
VL - 102
SP - 809
EP - 813
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 7
ER -