Does coronary artery revascularization before major vascular surgery benefit patients with coronary artery disease?

Barry Rubin* and W Scott Beattie

This article has no abstract so we have provided the first paragraph of the full text.

To fully understand the results of this landmark study by McFalls et al. we believe they should be considered in the context of the population studied. Of 5,898 patients, only 510 (9%) were randomized to prophylactic coronary revascularization or medical therapy. Some physicians might not consider the 510 patients to be high risk and therefore require coronary angiography, as only 48.6% had a revised cardiac risk index (RCRI) score of 2 or more, and 44% had a positive stress test. Notably, American College of Cardiology/American Heart Association guidelines support preoperative coronary angiography for selected vascular patients with known or suspected stable coronary artery disease only upon noninvasive tests showing significant inducible ischemia.¹ The low percentage of patients with triple vessel disease and exclusion of patients with left main disease limits how the results can be applied to the management of high-risk patients requiring vascular surgery.

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