Prevalence and Severity of Asymptomatic Coronary and Carotid Artery Disease in Patients With Abdominal Aortic Aneurysm

Marsico, Fabio; Giugliano, Giuseppe; Ruggiero, Donatella; Parente, António; Paolillo, Stefania; Guercio, Luca del; Esposito, Giovanni; Trimarco, Bruno; Filardi, Pasquale Perrone

doi:10.1177/0003319714540319

Cited by 18 publications

(9 citation statements)

References 24 publications

(46 reference statements)

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“…Because elective open surgical aneurysm repair is considered high-risk surgery, when AAA and symptomatic CAD are detected, coronary artery revascularization (PCI or CABG) should be performed before AAA open repair [30]. However, the prevalence of asymptomatic, significant CAD in patients with AAA was found to be as high as 61% and, moreover, 31% of these patients fulfilled indications for coronary revascularization [31]. There is, therefore, a significant group of patients with asymptomatic but severe CAD that do not undergo coronary artery evaluation and necessary revascularization before high-risk AAA surgery.…”

Section: Discussionmentioning

confidence: 99%

Coexistence and management of abdominal aortic aneurysm and coronary artery disease

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Coexistence and management of abdominal aortic aneurysm and coronary artery disease

et al. 2020

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“…The association between AAAs and carotid artery stenosis, 2 –5 ischemic heart disease, 6,7 or coronary artery stenosis 8 –10 is well documented. Abdominal aortic aneurysms share the same vascular risk factors with these diseases (eg, smoking, hyperlipidemia, and hypertension).…”

Section: Abdominal Aortic Aneurysms and Vascular Disease In Other Artmentioning

confidence: 99%

The Association Between Abdominal Aortic Aneurysms With Cardiovascular and Noncardiovascular Diseases

2018

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“…The presence of AAA is considered an equivalent risk factor as CAD [ 10 ]. It has been shown that patients affected by AAAs of any size have a risk of major cardiovascular events (MACE, including cardiovascular death or non-fatal acute myocardial infarction [MI]) that is greater than 20% at 10 years, with an additional risk of aneurysm rupture [ 11 , 12 ]. This high risk of MACE is mainly attributed to the presence of coronary and vascular disease, mostly asymptomatic [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Peripheral Artery Disease and Abdominal Aortic Aneurysm: The Forgotten Diseases in COVID-19 Pandemic. Results from an Observational Study on Real-World Management

et al. 2021

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Background and Objectives: It is well established that patients with peripheral artery disease (PAD) as well abdominal aortic aneurysm (AAA) have an increased cardiovascular (CV) mortality. Despite this higher risk, PAD and AAA patients are often suboptimality treated. This study assessed the CV profile of PAD and AAA patients, quantifying the survival benefits of target-based risk-factors modification even in light of the COVID-19 pandemic. Materials and Methods: PAD and AAA patients admitted for any reason to the Vascular Unit from January 2019 to February 2020 were retrospectively analyzed. Biochemical and CV profiles as well as ongoing medical therapies were recorded. Benefits of CV risk-factors control were estimated using the SMART-REACH model. A follow-up visit during the year 2020 was scheduled. Results: A total of 669 patients were included. Of these, 190 showed AAA and 479 PAD at any stage. Only 54% of PAD and 41% of AAA patients were on lipid-lowering drugs with non-optimal low-density lipoprotein (LDL) levels for most of them. A better control of all modifiable CV risk-factors based on the current guidelines would offer an absolute risk reduction of the mean 10-year CV risk by 9% in PAD and 14% in AAA. Unfortunately, the follow-up visit was lost because of COVID-19 limitations. Conclusions: Lipid profiles of PAD and AAA patients were far from guideline-based targets, and medical management was suboptimal. In our center, the COVID-19 pandemic impacted on the strict surveillance required in these very high-risk patients. The achievement of guideline-based therapeutic targets would definitively confer additional significant benefits in reducing the CV risk in these patients.

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Prevalence and Severity of Asymptomatic Coronary and Carotid Artery Disease in Patients With Abdominal Aortic Aneurysm

Cited by 18 publications

References 24 publications

Coexistence and management of abdominal aortic aneurysm and coronary artery disease

Coexistence and management of abdominal aortic aneurysm and coronary artery disease

The Association Between Abdominal Aortic Aneurysms With Cardiovascular and Noncardiovascular Diseases

Peripheral Artery Disease and Abdominal Aortic Aneurysm: The Forgotten Diseases in COVID-19 Pandemic. Results from an Observational Study on Real-World Management

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