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Previous Volume 351:2795-2804 December 30, 2004 Number 27 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Moscucci, M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

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.

Source Information

From the Minneapolis Veterans Affairs (VA) Medical Center (E.O.M., H.B.W., G.P., S.S., C.J.) and the Department of Medicine, Division of Cardiology (E.O.M., G.P.), and the Department of Surgery (S.S.), Division of Cardiovascular and Thoracic Surgery (H.B.W.), University of Minnesota — all in Minneapolis; the Cooperative Studies Program Coordinating Center (T.E.M., L.T., N.E., D.J.R.) and the Division of Peripheral Vascular Surgery (F.L.), VA Medical Center, Hines, Ill.; Southern Arizona VA Health Care System and the University of Arizona Sarver Heart Center — both in Tucson (S.G.); the Denver VA Medical Center, Denver (W.C.K., B.H.); the Department of Surgery (J.R.) and the Division of Cardiology (K.S.), University of California, San Francisco; San Francisco VA Medical Center, San Francisco (J.R., K.S.); and the University of Colorado Health Outcomes Program, Aurora, and the Department of Preventive Medicine and Biometrics, University of Colorado, Denver (W.G.H.).

Dr. Krupski is deceased.

Address reprint requests to Dr. McFalls at the Division of Cardiology, VA Medical Center, 1 Veterans Dr., Minneapolis, MN 55417, or at mcfal001{at}tc.umn.edu.

Full Text of this Article

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Coronary Revascularization before Vascular Surgery
Landesberg G., Mosseri M., Fleisher L. A., Auer J., Lamm G., Eber B., Brett A. S., McFalls E. O., Ward H. B., Moritz T., Moscucci M., Eagle K. A.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:1492-1495, Apr 7, 2005. Correspondence

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