Revascularization Not Linked to Long-Term Benefit

Patients had at least three cardiac risk factors before undergoing major vascular surgery

18 april 2009-- In patients with high cardiac risk undergoing major vascular surgery, preoperative coronary revascularization was not associated with better long-term outcomes, according to research published April 1 in the American Journal of Cardiology.
Olaf Schouten, M.D., of the Erasmus Medical Center in Rotterdam, Netherlands, and colleagues analyzed data from 101 patients scheduled for major vascular surgery who had at least three cardiac risk factors, such as congestive heart failure or previous myocardial infarction. Those with extensive stress-induced ischemia were randomized to preoperative revascularization or no revascularization.
Over a median follow-up of 2.8 years, overall survival was 64 percent in patients assigned to the no-revascularization group, and 61 percent in the revascularization group, which was not significantly different. Rates were also similar between the groups for cardiac event-free survival after 2.8 years, the investigators found.
"Findings from both the Coronary Artery Revascularization Prophylaxis trial and this study supported the current guidelines of the American College of Cardiology/American Heart Association for perioperative management in high-risk patients to reserve revascularization for cardiac unstable patients," the authors write. "Considering the high long-term mortality and cardiac event rates, these patients should be regularly screened for the presence of ischemic symptoms, and aggressive anti-ischemic medical therapy must be used."
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