Vol 27, No 4 (2020)
Original articles — Clinical cardiology
Published online: 2018-09-07
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.
Keywords: abdominal aortic aneurysmcoronary artery aneurysmcoronary arteriographycoronary artery disease
References
- Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(41): 2873–2926.
- Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011; 41 Suppl 1: S1–S58.
- Dereziński T, Fórmankiewicz B, Migdalski A, et al. Występowanie tętniaków aorty brzusznej w populacji miejsko-wiejskiej w centralnej Polsce — Gniewkowo Aortic Study. Kardiol Pol. 2017; 75(7): 705–710.
- Golledge J, Muller J, Daugherty A, et al. Abdominal aortic aneurysm: pathogenesis and implications for management. Arterioscler Thromb Vasc Biol. 2006; 26(12): 2605–2613.
- Ye Zi, Bailey KR, Austin E, et al. Family history of atherosclerotic vascular disease is associated with the presence of abdominal aortic aneurysm. Vasc Med. 2016; 21(1): 41–46.
- Antiochos P, Monney P, Fournier S, et al. Endovascular management of heavily calcified abdominal aorta dissection during transcatheter aortic valve implantation. Cardiol J. 2016; 23(6): 655–656.
- Treptau J, Ebnet J, Akin M, et al. Angiographic detection of fatal acute aortic dissection Stanford type A under resuscitation. Cardiol J. 2016; 23(6): 620–622.
- Van Kuijk JP, Flu WJ, Dunckelgrun M, et al. Coronary artery disease in patients with abdominal aortic aneurysm: a review article. J Cardiovasc Surg (Torino). 2009; 50(1): 93–107.
- Elkalioubie A, Haulon S, Duhamel A, et al. Meta-Analysis of abdominal aortic aneurysm in patients with coronary artery disease. Am J Cardiol. 2015; 116(9): 1451–1456.
- Hertzer NR, Beven EG, Young JR, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984; 199(2): 223–233.
- Mukai S, Yao H, Miyamoto T, et al. The long-term follow-up results of elective surgical treatment for abdominal aortic aneurysms. Ann Thorac Cardiovasc Surg. 2002; 8(1): 38–41.
- Roger VL, Ballard DJ, Hallett JW, et al. Influence of coronary artery disease on morbidity and mortality after abdominal aortic aneurysmectomy: a population-based study, 1971-1987. J Am Coll Cardiol. 1989; 14(5): 1245–1252.
- Rinckenbach S, Hassani O, Thaveau F, et al. Current outcome of elective open repair for infrarenal abdominal aortic aneurysm. Ann Vasc Surg. 2004; 18(6): 704–709.
- Sasaki Y, Isobe F, Kinugasa S, et al. Influence of coronary artery disease on operative mortality and long-term survival after abdominal aortic aneurysm repair. Surg Today. 2004; 34(4): 313–317.
- Hosokawa Y, Takano H, Aoki A, et al. Management of coronary artery disease in patients undergoing elective abdominal aortic aneurysm open repair. Clin Cardiol. 2008; 31(12): 580–585.
- Borioni R, Tomai F, Pederzoli A, et al. Coronary risk in candidates for abdominal aortic aneurysm repair: a word of caution. J Cardiovasc Med (Hagerstown). 2014; 15(11): 817–821.
- McFalls EO, Ward HB, Moritz TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004; 351(27): 2795–2804.
- Sun T, Cheng Yt, Zhang Hj, et al. Severe coronary artery disease in Chinese patients with abdominal aortic aneurysm: prevalence and impact on operative mortality. Chin Med J (Engl). 2012; 125(6): 1030–1034.
- Wolff T, Baykut D, Zerkowski HR, et al. Combined abdominal aortic aneurysm repair and coronary artery bypass: presentation of 13 cases and review of the literature. Ann Vasc Surg. 2006; 20(1): 23–29.
- Sumin AN, Korok EV, Panfilov SD, et al. [Myocardial revascularization before abdominal aortic surgery in patients with ischemic heart disease]. Kardiologiia. 2013; 53(4): 62–68.
- Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014; 35(35): 2383–2431.
- Markis JE, Joffe CD, Cohn PF, et al. Clinical significance of coronary arterial ectasia. Am J Cardiol. 1976; 37(2): 217–222.
- Sutzko DC, Andraska EA, Obi AT, et al. Risk factors associated with perioperative myocardial infarction in major open vascular surgery. Ann Vasc Surg. 2018; 47: 24–30.
- Kioka Y, Tanabe A, Kotani Y, et al. Review of coronary artery disease in patients with infrarenal abdominal aortic aneurysm. Circ J. 2002; 66(12): 1110–1112.
- Kishi K, Ito S, Hiasa Y. Risk factors and incidence of coronary artery lesions in patients with abdominal aortic aneurysms. Intern Med. 1997; 36(6): 384–388.
- Hernesniemi JA, Vänni V, Hakala T. The prevalence of abdominal aortic aneurysm is consistently high among patients with coronary artery disease. J Vasc Surg. 2015; 62(1): 232–240.e3.
- Takagi H, Umemoto T. ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Coronary artery disease and abdominal aortic aneurysm growth. Vasc Med. 2016; 21(3): 199–208.
- Poldermans D, Schouten O, Vidakovic R, et al. A clinical randomized trial to evaluate the safety of a noninvasive approach in high-risk patients undergoing major vascular surgery: the DECREASE-V Pilot Study. J Am Coll Cardiol. 2007; 49(17): 1763–1769.
- Kordowicz A, Ghosh J, Baguneid M. A single centre experience of simultaneous open abdominal aortic aneurysm and cardiac surgery. Interact Cardiovasc Thorac Surg. 2010; 10(1): 63–66.
- Jaffery Z, Grant A. Multisystem revascularization. Ochsner J. 2009; 9(4): 211–219.
- Marsico F, Giugliano G, Ruggiero D, et al. Prevalence and severity of asymptomatic coronary and carotid artery disease in patients with abdominal aortic aneurysm. Angiology. 2015; 66(4): 360–364.
- Abou Sherif S, Ozden Tok O, Taşköylü Ö, et al. Coronary artery aneurysms: a review of the epidemiology, pathophysiology, diagnosis, and treatment. Front Cardiovasc Med. 2017; 4: 24.
- Balderston JR, Giri J, Kolansky DM, et al. Coronary artery aneurysms associated with ascending aortic aneurysms and abdominal aortic aneurysms: pathophysiologic implications. Catheter Cardiovasc Interv. 2015; 85(6): 961–967.
- Cohen P, O'Gara PT. Coronary artery aneurysms: a review of the natural history, pathophysiology, and management. Cardiol Rev. 2008; 16(6): 301–304.
- Lamblin N, Bauters C, Hermant X, et al. Polymorphisms in the promoter regions of MMP-2, MMP-3, MMP-9 and MMP-12 genes as determinants of aneurysmal coronary artery disease. J Am Coll Cardiol. 2002; 40(1): 43–48.
- Kuivaniemi H, Platsoucas CD, Tilson MD. Aortic aneurysms: an immune disease with a strong genetic component. Circulation. 2008; 117(2): 242–252.
- al-Harthi SS, Nouh MS, Arafa M, et al. Aneurysmal dilatation of the coronary arteries: diagnostic patterns and clinical significance. Int J Cardiol. 1991; 30(2): 191–194.
- Baman TS, Cole JH, Devireddy CM, et al. Risk factors and outcomes in patients with coronary artery aneurysms. Am J Cardiol. 2004; 93(12): 1549–1551.
- Mariscalco G, Mantovani V, Ferrarese S, et al. Coronary artery aneurysm: management and association with abdominal aortic aneurysm. Cardiovasc Pathol. 2006; 15(2): 100–104.
- Botto F, Alonso-Coello P, Chan MTV, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014; 120(3): 564–578.
