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Pre-operative coronary revascularization: an optimal therapy for high-risk vascular surgery patients?

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Cardiac complications are the leading cause of peri-operative morbidity and mortality of patients undergoing vascular surgery. This high incidence of cardiac complications is related to the presence of underlying coronary artery disease. The optimal treatment strategy for these high-risk patients, including the use of pre-operative coronary revascularization for the purpose of improving peri-operative and long-term cardiac outcomes, has been controversial for several decades. Recently, the results of the Coronary Artery Revascularization Prophylaxis (CARP) trial showed that in the short term there is no reduction in the number of post-operative myocardial infarctions, deaths or length of stay in the hospital, or in long-term outcomes in patients who underwent pre-operative coronary revascularization compared with patients who received optimized medical therapy. In this review, we summarize the role of pre-operative revascularization before elective vascular surgery using current evidence from the CARP trial and of those from published studies.
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Keywords: cardiac risk reduction; coronary revascularization; percutaneous coronary intervention; vascular surgery

Document Type: Research Article

Affiliations: 1: Anaesthesia and Intensive Care, University of Pecs School of Medicine, Pecs, Hungary 2: Cardiothoracic Surgery, Semmelweis University, Budapest, Hungary

Publication date: August 1, 2006

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