Routine coronary angiography prior to abdominal aortic aneurysm repair: incidence of silent coronary artery disease

Objective. Routine coronary angiogram (CAG) was performed in patients prior to elective repair of abdominal aortic aneurysm (AAA) to estimate the incidence of coronary artery disease (CAD) and to compare with risk factors for CAD and resting electrocardiogram (ECG), Methods. History of CAD, risk factors for CAD, resting EGG, and standard CAG were assessed in 50 consecutive AAA patients. Results, Nine patients had a history of CAD. Risk factors included: smoking in 82%, hypertension in 58%, hypercholesterolemia in 42%, and diabetes in 18%. CAG revealed that 46% of the patients had severe CAD with greater than a 75% stenosis of one or more coronary arteries, There was no relationship between the number of risk factors and prevalence of CAD. Eleven patients who had severe CAD as detected by CAG had no history of CAD and displayed no ischemic findings on EGG. No perioperative myocardial infarctions or angial attacks mere noted despite the absence of prophylactic coronary interventions or revascularizations. Conclusions. The prevalence of severe CAD was 46% and incidence of silent CAD was 22% in this AAA population. The numbers of coronary risk factors and resting ECG were not worthwhile for predicting silent CAD.