Document Detail


Long-term outcome of prophylactic coronary revascularization in cardiac high-risk patients undergoing major vascular surgery (from the randomized DECREASE-V Pilot Study).
MedLine Citation:
PMID:  19327412     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Prophylactic coronary revascularization in vascular surgery patients with extensive coronary artery disease was not associated with an improved immediate postoperative outcome. However, the potential long-term benefit was unknown. This study was performed to assess the long-term benefit of prophylactic coronary revascularization in these patients. Of 1,880 patients scheduled for major vascular surgery, 430 had > or =3 risk factors (age >70 years, angina pectoris, myocardial infarction, heart failure, stroke, diabetes mellitus, and renal failure). All underwent cardiac testing using dobutamine echocardiography or nuclear stress imaging. Patients with extensive stress-induced ischemia (> or =5 segments or > or =3 walls) were randomly assigned to additional revascularization. In total, 101 patients showed extensive ischemia and were assigned to revascularization (n = 49) or no revascularization (n = 52). After 2.8 years, the overall survival rate was 64% for patients randomly assigned to no preoperative coronary revascularization versus 61% for patients assigned to preoperative coronary revascularization (hazard ratio [HR] 1.18, 95% confidence interval [CI] 0.63 to 2.19, p = 0.61). Rates for survival free of all-cause death, nonfatal myocardial infarction, and coronary revascularization were similar in both groups at 49% and 42% for patients allocated to medical treatment or coronary revascularization, respectively (HR 1.51, 95% CI 0.89 to 2.57, p = 0.13). Only 2 patients assigned to medical treatment required coronary revascularization during follow-up. Also, in patients who survived the first 30 days after surgery, there was no apparent benefit of revascularization on cardiac events (HR 1.35, 95% CI 0.72 to 2.52, p = 0.36). In conclusion, preoperative coronary revascularization in high-risk patients undergoing major vascular surgery was not associated with improved postoperative or long-term outcome compared with the best medical treatment.
Authors:
Olaf Schouten; Jan-Peter van Kuijk; Willem-Jan Flu; Tamara A Winkel; Gijs M J M Welten; Eric Boersma; Hence J M Verhagen; Jeroen J Bax; Don Poldermans;
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-02-07
Journal Detail:
Title:  The American journal of cardiology     Volume:  103     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-30     Completed Date:  2009-04-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  897-901     Citation Subset:  AIM; IM    
Affiliation:
Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Disease-Free Survival
Echocardiography, Stress
Electrocardiography
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Myocardial Ischemia / diagnosis,  epidemiology,  prevention & control*
Myocardial Revascularization / methods*
Pilot Projects
Postoperative Complications / epidemiology,  prevention & control*
Risk Factors
Survival Rate / trends
Time Factors
Treatment Outcome
Vascular Surgical Procedures*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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