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Evidence-Based Medicine 2005;10:114; doi:10.1136/ebm.10.4.114
Copyright © 2005 by the BMJ Publishing Group Ltd.
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Therapeutics

Prophylactic coronary artery revascularisation before elective vascular surgery did not improve long term survival

McFalls EO, Ward HB, Moritz TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 2004;351:2795–804.[Abstract/Free Full Text]

Q In patients with stable coronary artery disease (CAD) who are scheduled for elective major vascular surgery, does prophylactic coronary artery revascularisation reduce long term, all cause mortality?

Clinical impact ratings GP/FP/Primary care ******{star} IM/Ambulatory care ******{star} Internal medicine ******{star} Cardiology ******{star}

Key Words: angioplasty • transluminal • percutaneous coronary • coronary artery bypass • coronary disease • vascular surgical procedures

The first 150 words of the full text of this article appear below.

METHODS
{ebmflochart.f1}Design: randomised controlled trial (RCT) (Coronary Artery Revascularization Prophylaxis [CARP] trial).

{ebmclsdenvelop.f1}Allocation: {concealed*}{dagger}.

{ebmhalfeye.f1}Blinding: blinded ({investigators}{dagger} and the endpoints committee that validated all outcomes).*

{ebmhourglass.f1}Follow up period: median 2.7 years.

{ebmglobe.f1}Setting: 18 Veterans Affairs medical centres in the US.

{ebmpatient.f1}Patients: 510 patients (mean age 66 y, 98% men) with stable CAD (>=70% stenosis in >=1 major coronary artery suitable for revascularisation) who were scheduled for elective major vascular operation for an expanding abdominal aortic aneurysm or severe symptoms of arterial occlusive disease involving the legs. 65% (n = 332) had >=3 clinical factors for high surgical risk. 62% (n = 312) received nuclear stress testing, and 44% (n = 226) of the total population had moderate or severe defects. Exclusion criteria were a need for urgent or emergency surgery, severe comorbid conditions, or previous revascularisation without evidence of recurrent ischaemia.

{ebmrx.f1}Interventions: prophylactic preoperative coronary artery revascularisation (n . . . [Full text of this article]

P J Devereaux, MD1, Claudio S Cina, MD1, G Malaga Rodriguez, MD2

1 McMaster University
Hamilton, Ontario, Canada
2 Hospital Nacional Cayetano Heredia
Lima, Peru






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Copyright © 2005 by the BMJ Publishing Group Ltd.