Key result
Omitting preoperative coronary assessment before EVAR is linked to ~3.8-fold higher in-hospital adverse events.
Why the study?
The clinical utility of preoperative coronary assessment in patients undergoing endovascular aortic repair remains uncertain, and risk factors for combined aortic disease and CAD need clarification.
Does preoperative coronary assessment reduce in-hospital adverse events in patients undergoing elective endovascular aortic repair?
Cohort (n=1,139)
No
Does preoperative coronary assessment reduce in-hospital adverse events in patients undergoing elective endovascular aortic repair?
Odds Ratio: 3.779 (95% CI 1.645–8.681)
Absolute Event Rate: 2.6% vs 6%
p-value: p=0.002
Comprehensive preoperative coronary evaluation prior to EVAR allows for optimized medical management and is associated with enhanced procedural safety and a reduction in in-hospital adverse events.
Supports preoperative coronary evaluation to optimize safety in elective EVAR; leaves open whether protocol.
Objective The clinical utility of preoperative coronary assessment in patients undergoing endovascular aortic repair (EVAR) remains uncertain. This study aims to identify risk factors for aortic disease combined with coronary artery disease (CAD) and evaluate the impact of preoperative coronary assessment on in-hospital adverse events. Methods We conducted a single-center retrospective cohort study of patients undergoing elective EVAR at Beijing Anzhen Hospital (January 2021–June 2023). Participants were stratified by coronary assessment status within 12 months pre-surgery. Intergroup comparisons used two-independent samples t -tests and chi-square tests. In-hospital adverse events were a composite endpoint (all-cause mortality, acute myocardial infarction, acute heart failure, stroke, acute kidney injury, bleeding events, endoleak). Univariate logistic regression identified potential risk factors; variables with P < 0.10 were entered into multivariate logistic regression. Results A total of 1,139 patients were included, of whom 385 (33.8%) underwent preoperative coronary assessment. Among assessed patients, 278 with CAD received tailored management, including revascularization or optimized medical therapy. CAD risk varied across aortic disease subtypes ( P = 0.005); abdominal aortic aneurysm (AAA) patients had elevated risk ( OR = 2.113, P = 0.027). Age ( OR = 1.036, P = 0.014) and hyperlipidemia ( OR = 2.652, P < 0.001) were independent CAD risk factors. The non-assessment group had higher in-hospital adverse event rates (6.0% vs. 2.6%, P = 0.012), primarily due to major adverse cardiovascular events (MACE) (3.4% vs. 1.3%, P = 0.035). Preoperative assessment was associated with reduced adverse event risk; non-assessed patients had a 277.9% increased risk ( OR = 3.779, P = 0.002). Conclusion AAA patients have a substantially elevated risk of concurrent CAD. Comprehensive preoperative coronary evaluation before EVAR optimizes medical management and enables appropriate revascularization, enhancing procedural safety and reducing adverse cardiovascular events.
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Lei et al. (2026) conducted a cohort in Aortic disease (aortic aneurysm, dissection, or ulcer) (n=1,139). Preoperative coronary assessment vs. No preoperative coronary assessment was evaluated on Composite of in-hospital adverse events (all-cause mortality, acute myocardial infarction, acute heart failure, stroke, acute kidney injury, bleeding events, endoleak) (OR 3.779, 95% CI 1.645-8.681, p=0.002). Preoperative coronary assessment before EVAR was associated with a significant reduction in in-hospital adverse events (2.6% vs 6.0%), with non-assessment independently increasing risk by 277.9% (OR 3.779).
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