Coexistence and management of abdominal aortic aneurysm and coronary artery disease

Abstract

Background: Abdominal aortic aneurysm (AAA) and coronary atherosclerosis share common risk factors. In this study, a single-center management experience of patients with a coexistence of AAA and coronary artery disease (CAD) is presented. Methods: 271 consecutive patients who underwent elective AAA repair were reviewed. Coronary imaging in 118 patients was considered suitable for exploration of AAA coexistence with CAD. Results: Significant coronary stenosis (> 70%) were found in 65.3% of patients. History of cardiac revascularization was present in 26.3% of patients, myocardial infarction (MI) in 31.4%, and 39.8% had both. In a subgroup analysis, prior history of percutaneous coronary intervention (PCI) (OR = 6.9, 95% CI 2.6-18.2, p < 0.001) and patients' age (OR = 1.1, 95% CI 1.0-1.2, p = 0.007) were independent predictors of significant coronary stenosis. Only 52.0% (40/77) of patients with significant coronary stenosis underwent immediate coronary revascularization prior to aneurysm repair: PCI in 32 cases (4 drug-eluting stents and 27 bare metal stents), coronary artery bypass graft in 8 cases. Patients undergoing revascularization prior to surgery had longer mean time from coronary imaging to AAA repair (123.6 vs. 58.1 days, p < 0.001). Patients undergoing coronary artery evaluation prior to AAA repair had shorter median hospitalization (7 [2-70] vs. 7 [3-181] days, p = 0.007) and intensive care unit stay (1 [0-9] vs. 1 [0-70] days, p = 0.014) and also had a lower rate of major adverse cardiovascular events or multiple organ failure (0% vs. 3.9%, p = 0.035). A total of 11.0% of patients had coronary artery aneurysms. Conclusions: Patients with AAA might benefit from an early coronary artery evaluation strategy.

No Effect of Hypercholesterolemia on Elastase-Induced Experimental Abdominal Aortic Aneurysm Progression

“…In the current GoF mutant PCSK9 experiments, AAV infection alone, with or without a HFD, exerted no recognizable influence on experimental aneurysm progression or characteristic pro-aneurysmal aortic pathologies. Putative associations between PCSK9 variants or polygenetic lipid variant risk scores and AAA disease may be confounded by common risk factors for atherosclerosis and AAAs [46], or alterations in aortic inflammation, stiffness or structural features such as vascular-associated lymphoid tissues secondary to co-existing atherosclerosis may also link cholesterol to AAA risk [22][23][24][25][26][47][48][49]. Further analysis of AAA enlargement rates in patients treated with PCSK9 inhibitors (Alirocumab and Evolocumab) may provide further understanding of the role of serum lipid and cholesterol concentrations in clinical AAA disease.…”

Pulse Wave Velocity for Risk Stratification of Patients with Aortic Aneurysm

“…Patients with aortic aneurysms are at high cardiovascular risk [ 21 , 22 ]. Several studies have compared PWV in patients after endovascular aortic repair with matched but healthy controls [ 17 , 18 ].…”

Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm

“…Since the mortality of TAA/ AAA rupture is still very high, open surgery or endovascular aortic repair should be performed before rupture occurs (2)(3)(4). Furthermore, patients with TAA/AAA often have coronary artery disease (CAD), which results in an even greater mortality rate (5,6). Therefore, it is not uncommon for patients with TAA/AAA to undergo percutaneous coro-nary intervention (PCI) (6,7).…”

“…Furthermore, patients with TAA/AAA often have coronary artery disease (CAD), which results in an even greater mortality rate (5,6). Therefore, it is not uncommon for patients with TAA/AAA to undergo percutaneous coro-nary intervention (PCI) (6,7).…”