Document Detail


Coronary-artery revascularization before elective major vascular surgery.
MedLine Citation:
PMID:  15625331     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The benefit of coronary-artery revascularization before elective major vascular surgery is unclear. METHODS: We randomly assigned patients at increased risk for perioperative cardiac complications and clinically significant coronary artery disease to undergo either revascularization or no revascularization before elective major vascular surgery. The primary end point was long-term mortality. RESULTS: Of 5859 patients scheduled for vascular operations at 18 Veterans Affairs medical centers, 510 (9 percent) were eligible for the study and were randomly assigned to either coronary-artery revascularization before surgery or no revascularization before surgery. The indications for a vascular operation were an expanding abdominal aortic aneurysm (33 percent) or arterial occlusive disease of the legs (67 percent). Among the patients assigned to preoperative coronary-artery revascularization, percutaneous coronary intervention was performed in 59 percent, and bypass surgery was performed in 41 percent. The median time from randomization to vascular surgery was 54 days in the revascularization group and 18 days in the group not undergoing revascularization (P<0.001). At 2.7 years after randomization, mortality in the revascularization group was 22 percent and in the no-revascularization group 23 percent (relative risk, 0.98; 95 percent confidence interval, 0.70 to 1.37; P=0.92). Within 30 days after the vascular operation, a postoperative myocardial infarction, defined by elevated troponin levels, occurred in 12 percent of the revascularization group and 14 percent of the no-revascularization group (P=0.37). CONCLUSIONS: Coronary-artery revascularization before elective vascular surgery does not significantly alter the long-term outcome. On the basis of these data, a strategy of coronary-artery revascularization before elective vascular surgery among patients with stable cardiac symptoms cannot be recommended.
Authors:
Edward O McFalls; Herbert B Ward; Thomas E Moritz; Steven Goldman; William C Krupski; Fred Littooy; Gordon Pierpont; Steve Santilli; Joseph Rapp; Brack Hattler; Kendrick Shunk; Connie Jaenicke; Lizy Thottapurathu; Nancy Ellis; Domenic J Reda; William G Henderson
Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  351     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-12-30     Completed Date:  2005-01-14     Revised Date:  2007-05-18    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2795-804     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2004 Massachusetts Medical Society.
Affiliation:
Minneapolis Veterans Affairs Medical Center, Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis 55417, USA. mcfal001@tc.umn.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary* / mortality
Aortic Aneurysm, Abdominal / complications,  surgery
Arterial Occlusive Diseases / complications,  surgery
Coronary Artery Bypass* / mortality
Coronary Disease / complications,  drug therapy,  therapy*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications
Preoperative Care
Proportional Hazards Models
Surgical Procedures, Elective / mortality
Survival Analysis
Treatment Outcome
Vascular Surgical Procedures / mortality*
Comments/Corrections
Comment In:
N Engl J Med. 2004 Dec 30;351(27):2861-3   [PMID:  15625338 ]
Nat Clin Pract Cardiovasc Med. 2005 Apr;2(4):190-1   [PMID:  16265481 ]
N Engl J Med. 2005 Apr 7;352(14):1492-5; author reply 1492-5   [PMID:  15818775 ]
N Engl J Med. 2005 Apr 7;352(14):1492-5; author reply 1492-5   [PMID:  15814890 ]
N Engl J Med. 2005 Apr 7;352(14):1492-5; author reply 1492-5   [PMID:  15818774 ]
Perspect Vasc Surg Endovasc Ther. 2005 Jun;17(2):182-3   [PMID:  16110401 ]
CMAJ. 2005 Apr 26;172(9):1180-1   [PMID:  15851709 ]
ACP J Club. 2005 Jul-Aug;143(1):12   [PMID:  15989300 ]

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