Document Detail

Management of coronary artery disease in patients undergoing elective abdominal aortic aneurysm open repair.
MedLine Citation:
PMID:  19072880     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The efficacy of prophylactic coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in patients with abdominal aortic aneurysm (AAA) scheduled for open repair surgery remains controversial. HYPOTHESIS: Concomitant coronary artery disease (CAD) with no inducible ischemia can be medically treated in AAA patients undergoing open repair as long as the existence of CAD is recognized. METHOD: A retrospective analysis of acute and long-term outcomes was performed for 122 patients with AAA who underwent coronary arteriography (CAG) for preoperative evaluation followed by elective open repair. RESULTS: Preoperative CAG revealed no CAD in 54 patients (non-CAD group) and the existence of CAD in 68 patients. Prophylactic PCI or CABG surgery was performed in 16 patients (CAD-PCI/CABG group) with symptomatic angina, ischemia proven by pharmacological stress scintigraphy, or coexistence of reduced cardiac contraction and coronary stenosis in multiple vessels. Medical treatment was administered to 52 patients who had no signs of ischemia (CAD-medical group). During the perioperative period, no cardiac event occurred irrespective of the existence of CAD. The long-term outcomes in the CAD-medical group were equivalent to those in the non-CAD group. In the CAD-PCI/CABG group, the cardiac event-free rate was comparable with that of other groups, although mortality was higher. CONCLUSION: In patients undergoing AAA open repair, medical treatment for concomitant CAD with no obvious inducible ischemia does not confer unfavorable outcomes. Although prophylactic coronary revascularization possibly prevents future cardiac events, it appears to be necessary in a very limited number of cases.
Yusuke Hosokawa; Hitoshi Takano; Asako Aoki; Toru Inami; Michio Ogano; Nobuaki Kobayashi; Jun Tanabe; Hiroyuki Yokoyama; Takayoshi Kato; Hisato Takagi; Takuya Umemoto; Morimasa Takayama; Kyoichi Mizuno
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  31     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-25     Completed Date:  2009-02-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  580-5     Citation Subset:  IM    
Copyright Information:
(c) 2008 Wiley Periodicals, Inc.
Department of Cardiovascular Medicine, Shizuoka Medical Center, Shizuoka, Japan.
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MeSH Terms
Aged, 80 and over
Aortic Aneurysm, Abdominal / epidemiology*,  mortality,  surgery*
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Disease / epidemiology*,  surgery,  therapy*
Kaplan-Meiers Estimate
Middle Aged
Surgical Procedures, Elective

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

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