For high-risk patients, what is the mortality benefit of revascularization prescribed based on pre-operative cardiac work-up?

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.

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About Amy

Clinical Informationist at EUH Branch Library
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