SELECTIVE SCREENING FOR CORONARY-ARTERY DISEASE IN PATIENTS UNDERGOING ELECTIVE REPAIR OF ABDOMINAL AORTIC-ANEURYSMS

Purpose: The purpose of this study was to retrospectively evaluate the effectiveness of screening for coronary artery disease before electiv e repair of abdominal aortic aneurysms (AAA) was performed. Methods: R esults of a screening algorithm for coronary artery disease in 263 pat ients admitted to a single hospital for elective repair of AAA between January 1986 and December 1989 were analyzed. Patients with no corona ry artery discase indicators proceeded to surgery without further work up. Patients with cardiac disease indicators underwent dipyridamole-th allium scintigraphy, and patients with angina were screened by use of cardiac catheterization; those with a recent coronary revascularizatio n underwent no additional screening unless symptoms or electrocardiogr aphic changes suggested an intervening event. Twenty-eight patients un derwent no screen other than medical history and electrocardiogram. Re sults: Among 164 patients screened with dipyridamole-thallium scintigr aphy, 44 patients had redistribution defects that required catheteriza tion, and 11 of these underwent coronary revascularization. Cardiac ca theterization was performed directly in 42 patients, which led to 11 r evascularizations before AAA repair. Previous coronary artery bypass o r percutaneous transluminal angioplasty obviated additional screening in 29 patients. Of the 263 scheduled AAA repairs, 15 were cancelled be cause of unacceptable operative risks, 13 for cardiac reasons. One pat ient died of a ruptured AAA after an uneventful coronary artery bypass . Among the 247 AAA repairs performed, there were three perioperative deaths (1.2%), all of which resulted from sudden cardiac events; three additional patients had nonfatal myocardial infarctions (1.2%), for a total cardiac complication rate of 2.4%. Conclusions: The low rate of cardiac complications in this experience affirms the effectiveness of preoperative screening and selective coronary revascularization befor e AAA repair.