Optimization of Preoperative Cardiac Risk Assessment in Elective Endovascular Repair of Abdominal Aortic Aneurysm: Analysis of In-Hospital Outcomes

Background: Assessment of cardiac risk before elective endovascular repair of abdominal aortic aneurysm remains an important issue. Conventional risk stratification scores have limited accuracy in patients undergoing endovascular procedures and do not account for the high prevalence of severe asymptomatic coronary artery disease in patients with abdominal aortic aneurysms. Objective: To evaluate the safety and efficacy of a new perioperative management algorithm for patients undergoing elective endovascular repair of an abdominal aortic aneurysm. Materials and methods: This retrospective single-center study included 109 patients. Group 1 (n = 64) consisted of patients who underwent surgery in 2019–2022 using a standard approach to cardiac risk assessment. Group 2 (n = 45) included patients who underwent surgery in 2022–2024 and were managed according to an optimized approach that included risk stratification using the VQI-CRI score and coronary angiography in high-risk patients. The timing and strategy of myocardial revascularization were determined according to the severity of coronary lesions and the risk of aneurysm rupture. Results: The proportion of patients with high cardiac risk was comparable between the groups. However, coronary angiography was performed significantly more frequently in high-risk patients in Group 2 (95% vs 31%, p < 0.001). Significant coronary artery lesions were detected more frequently in Group 2 (33.3% of all patients and 73.7% of high-risk patients), including severe forms of coronary artery disease ( p = 0.026). Myocardial revascularization was performed in all 22 patients with significant coronary lesions. No adverse events were observed during the between-stage period. The rates of in-hospital complications and mortality did not differ between the groups. Conclusion: Optimization of the preoperative management strategy in patients undergoing elective endovascular repair of abdominal aortic aneurysms improves the detection of concomitant coronary artery disease. The proposed algorithm enables the identification of severe, including asymptomatic, forms of the disease, allowing timely treatment of these lesions. The proposed strategy is not associated with an increase in in-hospital complications.