Bottom line: In patients with coronary disease risk factors, prophylactic coronary revascularization plus optimal medical therapy may not provide mortality benefit over optimal medical therapy alone.
Summary: Schouten O, et al. Long-term outcome of prophylactic coronary revascularization in cardiac high-risk patients undergoing major vascular surgery (from the randomized DECREASE-V Pilot Study). Am J Cardiol. 2009 Apr 1;103(7):897-901.
RCT that enrolled patients who 1) were scheduled for elective open abdominal aortic or infrainguinal arterial reconstruction, 2) were positive for 3 or more cardiac risk factors (age > 70, angina pectoris, hx of MI, hx of CHF, treatment for diabetes mellitus, hx of stroke or TIA, kidney dysfunction,) 3) experienced stress-induced myocardial ischemia on stress test prior to surgery. Randomized to receive best medical treatment plus preoperative coronary revascularization (n=49) or best medical treatment (n=52).
RESULTS: Figures 1-4 (p. 899) compare survival of patients in the two groups. After 2.8 years follow-up, survival rate was 61% for patients receiving preoperative coronary revascularization compared to 64% for patients who did no receive revascularization.