Abstract 3346: Preoperative Coronary Artery Revascularization and Long-term Outcome in Patients with Abdominal Aortic Operations and Myocardial Ischemia on SPECT: A Post-hoc Analysis of The CARP Trial
The Coronary Artery Revascularization Prophylaxis (CARP) Trial was a randomized controlled trial that tested the benefit of coronary artery revascularization prior to elective vascular surgery. The purpose of this post-hoc analysis was to determine the impact of preoperative coronary artery revascularization on the long-term reduction of death and non-fatal myocardial infarction (MI) among those patients with an abdominal aortic operation and preoperative ischemia by SPECT. One hundred and nine patients with myocardial ischemia on a preoperative SPECT were randomized to either revascularization (n=52) or no revascularization (n=57) prior to abdominal aortic surgery. Indications for the vascular operation were an expanding abdominal aneurysm in 62 (57%) and arterial-occlusive disease in 47 (43%). The long-term outcome was the composite end-point of death or non-fatal MI at any time following randomization. The univariate predictors of the composite end-point with P<0.200 were entered into a Cox proportional hazard model. The analysis demonstrated that the only multivariate predictors of long-term freedom from death or non-fatal MI were preoperative coronary artery revascularization (P=0.03) and the absence of anterior ischemia on SPECT (P=0.07). The effect of these two clinical variables on long-term outcome is shown in the Table⇓ (*P=0.02 versus patients with revascularization and no anterior ischemia). In summary, in this post-hoc analysis of the subset of patients within the CARP trial with an abdominal aortic vascular operation and preoperative ischemia by SPECT, coronary artery revascularization prior to vascular surgery reduced the long-term risk of death and non-fatal MI. The presence of anterior ischemia by SPECT also predicted a poor outcome, independent of the revascularization status. These data may help generate future hypotheses regarding the role of prophylactic interventions prior to high-risk abdominal aortic vascular operations.