Is Coronary Revascularization Beneficial Before Vascular Surgery?

Up to 50% of patients who undergo major noncardiac vascular surgery have coronary artery disease (CAD), but the benefit of preoperative coronary revascularization is unclear. Now, in a trial from several VA centers, researchers randomized 510 patients (mean LV ejection fraction, 54%) to coronary revascularization or to medical therapy alone, before major elective vascular surgery. All subjects had at least one vessel with ≥70% stenosis that was amenable to percutaneous coronary intervention or coronary artery bypass grafting (CABG); none had left-main artery disease or LVEFs <20%. The 510 patients who met these and other inclusion criteria represented only 9% of 5859 patients scheduled for vascular surgery.

At a median follow-up of 2.7 years…