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In the randomized CARP trial, patients with coronary disease who were scheduled for vascular surgery did not benefit from coronary revascularization before the noncardiac surgery (Journal Watch Jan 7 2005 and N Engl J Med 2004;351:2795). However, some people expressed concern that this trial did not include sufficient numbers of patients at highest risk for perioperative morbidity.
In a new study (the DECREASE-V Pilot Study), multinational researchers enrolled 101 high-risk patients scheduled for major vascular surgery. All patients had multiple risk factors and extensive stress-test–induced coronary ischemia, 67% had triple-vessel coronary disease, and nearly half had ejection fractions below 35%. Patients were randomized to receive either …