Coronary Revascularization Not Helpful Before Elective Vascular Surgery

Some published algorithms call for selected clinically stable patients with multiple cardiac risk factors to be directed toward stress testing and coronary revascularization before they undergo elective noncardiac surgery (ACC/AHA guidelines). The wisdom of this approach has not been subjected to a randomized trial -- until now.

U.S. researchers enrolled 510 patients scheduled to have elective surgery for either abdominal aortic aneurysm or severely symptomatic arterial occlusive disease of the legs. A cardiologist considered all patients to be at high risk for perioperative cardiac complications, and all underwent coronary angiograms that revealed one or more coronary arteries with at least 70% stenosis. These patients were randomized to un…