CORONARY-ARTERY DISEASE IN PATIENTS WITH AN ABDOMINAL AORTIC-ANEURYSM

Coronary artery disease is common in patients with abdominal aortic an eurysms (AAA). It is responsible for half the operative deaths explain ing the necessity of diagnosing asymptomatic coronary patients. Betwee n 1980 and 1993, 172 patients aged 47 to 92 years (average 69 years) w ere operated for AAA. Fifty-four of them (31 %) were known to have cor onary artery disease; 30 preoperative coronary angiograms and 16 proph ylactic coronary revascularisation procedures were performed before op erating the AAA. in cases with ruptured AAA (42 cases) the operative m ortality was 31 % (13 patients) compared with 6 % (8 patients) in thos e without rupture (130 cases). Myocardial disease was responsible for 25 % of all deaths (2 out of 8) and for 40 % of deaths (2 out of 6) in the subgroup of 54 coronary patients. The majority of non-lethal card iac complications also occured in this subgroup. On the other hand, no deaths were observed in the group of 16 patients who underwent myocar dial revascularisation beforehand. Follow-up of the 151 patients disch arged from hospital was complete (100 %). With an average follow-up pe riod of 3.5 years (range 5 months to 13 years), 39 secondary deaths ha ve been observed (26 %) including 6 (15 %) of cardiac causes. In addit ion, 3 patients in the coronary subgroup and 1 patient from the non-co ronary group underwent myocardial revascularisation after surgical cur e of their AAA. Coronary artery disease may be totally asymptomatic an d severe lesions go unrecognised; the main problem is therefore to det ect silent myocardial ischaemia in the absence of totally reliable non -invasive techniques, in order to perform preventive coronary revascul arisation in high risk patients before their surgery. Coronary angiogr aphy is essential in all documented cases of severe coronary artery di sease; exercise testing and thallium scintigraphy should be proposed i n cases with clinical or electrocardiographic presumption of angina. H owever, systematic investigation is not required in the absence of sug gestive symptoms.