Fatal Myocardial Infarction Following Abdominal Aortic Aneurysm Resection

Routine preoperative coronary angiography has been recommended to all patients scheduled for elective abdominal aortic aneurysm resection at the Cleveland Clinic since 1978. Patients found to have severe, correctable coronary artery disease (CAD) have been advised to undergo myocardial revascularization prior to aneurysm resection in an attempt to reduce the incidence of fatal postoperative myocardial infarction. In order to provide an historic standard with which the results of this approach may eventually be compared, complete follow-up information has been obtained for 96% of 343 consecutive patients who underwent abdominal aortic aneurysm resection between 1969 and 1973. Fatal myocardial infraction accounted for 37% of early postoperative deaths and occurred in 6% of the entire series. Among the patients who survived operation, the five-year mortality rate was 31% and the 11-year mortality rate was 52%. Complications of CAD caused 39% of the deaths that occurred within five years after operation and 41% of the deaths that occurred within 11 years. The late incidence of fatal myocardial infarction among patients who had preoperative evidence of CAD was statistically significant (p < 0.05).