Clinical Question: In patients with...

Clinical Question: In patients with significant, stable coronary disease, is coronary artery revascularization helpful before major vascular surgery?

Setting: Inpatient (any location) with outpatient follow-up

reflection Design: Randomized controlled trial (nonblinded)

Allocation: Concealed

Synopsis: Patients undergoing repair of an expanding abdominal aortic aneurysm (AAA) or peripheral vascular surgery underwent angiography if they were at high risk for cardiovascular complications onward the basis of standard guidelines. If single in kind or more coronary arteries had a 70 percent stenosis, the patient was randomized to receive revascularization (59 percent had angioplasty, 41 percent had a coronary artery bypass graft) or no revascularization. Of 5859 patients initially listed 1,654 were not at high risk, 1025 required importunate surgery, 626 had previous revascularization, 731 had a morose coexisting illness, 633 were already in another studious mood or declined to participate, and 680 were exclud for various other reasons. That left 510 patients for randomization; the clumps were balanced at the start of the study

Patients were followed for up to six years (mean follow-up time = 28 years). There were more deaths before surgery in the revascularization dispose (10 versus one), no difference in deaths in the 30 days after the peripheral vascular surgery or AAA repair (seven versus eight), and no difference in long-term all-cause mortality (22 versus 23 percent) The results were the same for intention-to-treat and per-protocol analyses.

Bottom Line: Patients with significant, stable coronary artery disease do not benefit from revascularization before major peripheral vascular surgery (Level of Evidence: lb)

meditation Reference: McFalls EO, et al. Coronary-artery revascularization before elective major vascular surgery N Engl J M December 30 2004;351:2795-804

Used with permission from Ebell M CABG not helpful before major vascular surgery Accessed online March 1 2005 at: http://wwwlnfoPOEMscom

COPYRIGHT 2005 American Academy of Family Physicians

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