Incidence and Relevance of Coronary Heart Disease in Patients undergoing Abdominal Aortic Aneurysm Repair

Background: To investigate the incidence and relevance of coronary heart disease in patients undergoing surgical or endovascular infrarenal abdominal aortic aneurysm (AAA) repair.

Methods: Between 01/2011 and 06/2022, 652 patients underwent elective AAA repair. Of those, 532 patients underwent prior invasive coronary angiography. Patient data were compared between patients with and without preoperative invasive coronary angiography.

Results: Patient characteristics and the incidence of cardiovascular risk factors were comparable between the two groups, except for a significantly higher incidence of hyperlipidemia (45% vs. 53%, p < 0.001) in patients with preoperative angiography. Coronary heart disease was diagnosed in 371 (70%) patients (1-vessel disease: n = 97 [18%], 2-vessel disease: n = 104 [20%], 3-vessel disease: n = 170 [32%]) resulting in a coronary artery intervention in 225 (42%) patients. Preoperative revascularization was performed in 152 (28%) patients (PCI: n = 124 [23%], CABG: n = 28 [5%]) and postoperative revascularization was performed in 73 (14%) patients (PCI: n = 65 [12%], CABG: n = 8 [2%]). In-hospital mortality tended to be better in patients with preoperative angiography (1% vs. 3%, p = 0.074) and long-term survival was significantly better in patients with preoperative angiography (log rank: p = 0.038).

Conclusion: Routine preoperative invasive coronary angiography revealed a high incidence of relevant coronary heart disease requiring treatment (PCI or CABG) in almost half of all AAA patients improving postoperative patient outcome and potentially long-term survival.

Publication History

Article published online:
13 February 2024