Does coronary angiography before emergency aortic surgery affect in-hospital mortality?

OBJECTIVES To study the relationship between coronary angiography and in-ho spital mortality in patients undergoing emergency surgery of the aorta with out a history of coronary revascularization or coronary angiography before the onset of symptoms. BACKGROUND In the setting of acute ascending aortic dissection warranting e mergency aortic repair, coronary angiography has been considered to be desi rable, if not essential. The benefits of defining coronary anatomy have to be weighed against the risks of additional delay before surgical interventi on. METHODS Retrospective analysis of patient charts and the Cardiovascular Inf ormation Registry (CVIR) at the Cleveland Clinic Foundation. RESULTS We studied 122 patients who underwent emergency surgery of the aort a between January 1982 and December 1997. Overall, in-hospital mortality wa s 18.0%, and there was no significant difference between those who had coro nary angiography on the day of surgery compared with those who had not (No: 16%, n = 81 vs. Yes: 22%, n = 41, p = 0.46). Multivariate analysis reveale d that a history of myocardial infarction (MI) was the only predictor of in -hospital mortality (relative risk: 4.98 95% confidence interval: 1.48-16.7 5, p = 0.009); however, coronary angiography had no impact on in-hospital m ortality in patients with a history of MI. Furthermore, coronary angiograph y did not significantly affect the incidence of coronary artery bypass graf ting (CABG) during aortic surgery (17% vs. 25%, Yes vs. No). Operative repo rts revealed that 74% of all CABG procedures were performed because of coro nary dissection, and not coronary artery disease. CONCLUSIONS These data indicate that determination of coronary anatomy may not impact on survival in patients undergoing emergency surgery of the aort a and support the concept that once diagnosed, patients should proceed as q uickly as possible to surgery. (C) 2000 by the American College of Cardiolo gy.