Abstract 14571: Abdominal Aortic Aneurysm in Patients with Coronary Artery Disease: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Abdominal Aortic Aneurysm (AAA) and atherosclerosis share common risk factors. The high coronary artery disease (CAD) prevalence among AAA patients is well known. However, the inverse relationship has been explored by few studies and no specific recommendation is available on AAA screening in patients with advanced atherosclerosis.The aim of this study was to assess AAA prevalence and risk factors in CAD patients. We conducted a systematic review and first meta-analysis searching in MEDLINE, EMBASE and Cochrane Library databases to identify studies that evaluated AAA prevalence and risk factors among CAD patients, through April 2012. Reference lists from included articles were also hand-searched to identify further relevant studies. Two independent authors determined studies eligibility and extracted data via standardized forms. Data were pooled using a fixed-effects or a random-effects model when statistically significant heterogeneity assessed by the chi(2)-test was present, to calculate overall AAA prevalence, combined odds ratios (OR) and 95% confidence intervals (CI). A total of 18 eligible studies involving 8501 patients with CAD met the inclusion criteria. Prevalence of AAA ranged from 0.48% to 18.2% and of >50 mm AAA, i.e. eligible for surgical repair, from 0% to 5.2%. Overall prevalence of AAA and of >50 mm AAA were 7.75% (95% CI: 5.29-10.21) and 0.69% (95% CI: 0.11-1.27), respectively. Five studies included a control population without CAD. Overall AAA prevalence tended to be lower in this group vs. CAD patients (p=0.06). Risk factors pooled analysis revealed that male sex, smoking, arterial hypertension and concomitant carotid artery stenosis were significantly associated with AAA in CAD patients (OR 2.15, 95% CI: 1.29-3.58, OR 1.72, 95% CI: 1.14-2.61, OR 1.57, 95% CI: 1.06-2.35, OR 2.14, 95% CI: 1.20-3.79, respectively). AAA prevalence tended to be higher when CAD patients had concomitant peripheral artery disease (OR 2.67, 95% CI: 0.82-8.61, p= 0.08). No association was evident with age and diabetes. In conclusion, AAA prevalence seems high in CAD patients, justifying the need for further large studies to evaluate the benefit of AAA screening in this specific patient population.