Document Detail


Myocardial revascularization before abdominal aortic aneurysmorrhaphy: effect of coronary angioplasty.
MedLine Citation:
PMID:  8350636     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Percutaneous transluminal coronary angioplasty (PTCA) has assumed an increasing role in the preoperative preparation of patients with an abdominal aortic aneurysm (AAA). The influence of this modality on perioperative morbidity and long-term outcome has not been substantiated. To determine the effect of PTCA, we analyzed a cohort of 2,452 patients who underwent repair of an AAA between 1980 and 1990 at our institution. We compared the cardiac morbidity, mortality, and survival of patients who had preoperative coronary revascularization by PTCA or coronary artery bypass grafting (CABG). The overall perioperative mortality for the 2,452 patients was 2.9%. Preoperative coronary revascularization was necessary in 100 patients (4.1%)--86 had CABG and 14 had PTCA. Of these 100 patients, 95% had cardiac symptoms. Patients selected for PTCA, in comparison with CABG, had significantly less three-vessel disease but not significant differences in cardiac history or ejection fraction. During the study period, the use of PTCA increased significantly. The perioperative rate of myocardial infarction for patients with prior CABG was 5.8% in comparison with 0% for those with prior PTCA. No hospital deaths occurred in either group. The median interval between coronary revascularization and repair of an AAA was 10 days for PTCA and 68 days for CABG. The 3-year survival was not statistically different between CABG (82.8%) and PTCA (92.3%) groups. The rate of late cardiac events (at 3 years) was 56.5% in the PTCA group and 27.3% in the CABG group. We conclude that PTCA as part of a highly selective approach to coronary revascularization before repair of an AAA minimizes cardiac-related events and death.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
J R Elmore; J W Hallett; R J Gibbons; J M Naessens; T C Bower; K J Cherry; P Gloviczki; P C Pairolero
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  68     ISSN:  0025-6196     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  1993 Jul 
Date Detail:
Created Date:  1993-09-14     Completed Date:  1993-09-14     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  637-41     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary*
Aortic Aneurysm, Abdominal / complications,  mortality,  surgery*
Coronary Artery Bypass* / mortality
Coronary Disease / complications,  surgery,  therapy
Female
Humans
Male
Postoperative Complications
Time Factors
Comments/Corrections
Comment In:
Mayo Clin Proc. 1993 Jul;68(7):713-5   [PMID:  8350648 ]

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


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