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CARP NEJM 2004 (Coronary Artery Revascularization Prophylaxis)

Prophylactic revascularisation of male patients with stable coronary artery-disease prior to AAA repair or surgery for lower limb arterial occlusive disease does not reduce short or long term mortality.
dx.doi.org/10.1056/NEJMoa...

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Coronary artery revascularisation in patients at high risk of perioperative cardiac complications before vascular surgery will improve long term mortality.

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Patients undergoing elective AAA repair or operation for lower limb arterial occlusive disease.
Coronary angio if cardiologist considers high risk for periop cardiac complications.
Included if >1 artery >70% stenosed.
Randomised to revasc or not revasc.

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510 pts randomised (98% male). No difference in primary outcome of long term mortality or secondary outcomes 30 day
mortality, MI, stroke, limb loss, or dialysis.

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1
-- Summary --
Prophylactic revascularisation of male patients with stable coronary artery disease prior to AAA repair or surgery for lower limb arterial occlusive disease does not reduce short or long term mortality.
-- Hypothesis --
Coronary artery revascularisation in patients at high risk of perioperative cardiac complications before vascular surgery will improve long term mortality.
-- Method --
Patients undergoing elective AAA repair or operation for lower limb arterial occlusive disease.
Coronary angio if cardiologist considers high risk for periop cardiac complications. Included if >1 artery >70% stenosed. Randomised to revasc or not revasc.
-- Results --
510 pts randomised (98% male). No difference in primary outcome of long term mortality or secondary outcomes 30 day
mortality, MI, stroke, limb loss, or dialysis.
-- Critique --
98% men
10 of revasc group (vs 1 in control grp) who received "uncomplicated" revasc died before operation ?why
Those with coronary stents taken off antiplatelets, so maybe higher mortality in this group because of this.

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