Abstract
Aortic aneurysm is an increasingly important public health problem with high morbidity and mortality. It is associated with coronary artery disease (CAD), which is a comorbidity of high incidence that is reported to worsen perioperative complications and long-term clinical outcomes in patients with an aortic aneurysm. Patients with significant coronary artery stenosis may require coronary revascularization and/or optimal medical therapy in the perioperative period of aneurysm surgery. However, the prognostic impact of non-significant coronary artery stenosis not indicated for coronary revascularization on clinical outcomes of patients with aortic aneurysms remains unclear. We performed coronary angiography on 239 consecutive patients with thoracic and abdominal aortic aneurysms before endovascular aortic repair or surgical repair. The patients were divided into the following 3 groups according to the severity of stenosis of major coronary arteries: non-CAD group (with < 25% stenosis), non-significant CAD group (with ≥ 25% but < 75% stenosis), and significant CAD group (with ≥ 75% stenosis). CAD was diagnosed in 133 (56%) patients consisting of 48 (20%) patients with non-significant CAD and 85 (36%) patients with significant CAD. Thirty-nine major adverse cardiovascular and cerebrovascular events (MACCEs) occurred in a median follow-up period of 723 days. Kaplan–Meier analysis revealed that the risk of MACCEs was higher in the significant and non-significant CAD groups than in the non-CAD group. Multivariate Cox proportional hazard regression analysis showed that the risk of MACCEs was equally high in the non-significant CAD and significant CAD groups compared to that in the non-CAD group after adjustment for confounding factors. CAD is significantly associated with poor outcomes in patients with aortic aneurysms, irrespective of the significance of CAD.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sidloff D, Choke E, Stather P, Bown M, Thompson J, Sayers R (2014) Mortality from thoracic aortic diseases and associations with cardiovascular risk factors. Circulation 130:2287–2294
Sidloff D, Stather P, Dattani N, Bown M, Thompson J, Sayers R, Choke E (2014) Aneurysm global epidemiology study: public health measures can further reduce abdominal aortic aneurysm mortality. Circulation 129:747–753
Freeman WK, Gersh BJ, Gloviczki P (1990) Abdominal aortic aneurysm and coronary artery disease: frequent companions, but an uneasy relationship. J Vasc Surg 12:73–77
Singh K, Bonaa KH, Jacobsen BK, Bjork L, Solberg S (2001) Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: the Tromso study. Am J Epidemiol 154:236–244
Rajbanshi BG, Charilaou P, Ziganshin BA, Rajakaruna C, Maryann T, Elefteriades JA (2015) Management of coronary artery disease in patients with descending thoracic aortic aneurysms. J Card Surg 30:701–706
Hosokawa Y, Takano H, Aoki A, Inami T, Ogano M, Kobayashi N, Tanabe J, Yokoyama H, Kato T, Takagi H, Umemoto T, Takayama M, Mizuno K (2008) Management of coronary artery disease in patients undergoing elective abdominal aortic aneurysm open repair. Clin Cardiol 31:580–585
Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery. Am Heart Assoc Circ 51:5–40
Bath MF, Gokani VJ, Sidloff DA, Jones LR, Choke E, Sayers RD, Bown MJ (2015) Systematic review of cardiovascular disease and cardiovascular death in patients with a small abdominal aortic aneurysm. Br J Surg 102:866–872
Little WC, Constantinescu M, Applegate RJ, Kutcher MA, Burrows MT, Kahl FR, Santamore WP (1988) Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation 78:1157–1166
Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes DR Jr, Lerman A (2000) Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation 101:948–954
Girardi LN, Rabotnikov Y, Avgerinos DV (2014) Preoperative percutaneous coronary intervention in patients undergoing open thoracoabdominal and descending thoracic aneurysm repair. J Thorac Cardiovasc Surg 147:163–168
McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG (2004) Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 351:2795–2804
Poldermans D, Schouten O, Vidakovic R, Bax JJ, Thomson IR, Hoeks SE, Feringa HH, Dunkelgrun M, de Jaegere P, Maat A, van Sambeek MR, Kertai MD, Boersma E (2007) A clinical randomized trial to evaluate the safety of a noninvasive approach in high-risk patients undergoing major vascular surgery: the DECREASE-V Pilot Study. J Am Coll Cardiol 49:1763–1769
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflict of interest to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Watanabe, K., Watanabe, T., Otaki, Y. et al. Impact of pre-operative coronary artery disease on the clinical outcomes of patients with aortic aneurysms. Heart Vessels 36, 308–314 (2021). https://doi.org/10.1007/s00380-020-01700-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-020-01700-2