CARP
Trial question
What is the role of coronary artery revascularization in patients at increased risk for perioperative cardiac complications and clinically significant coronary artery disease?
Study design
Multi-center
Open label
RCT
Population
510 patients
Inclusion criteria: patients at increased risk for perioperative cardiac complications and clinically significant coronary artery disease
Key exclusion criteria: need for urgent or emergency surgery, a severe coexisting illness, or prior revascularization without evidence of recurrent ischemia
Interventions
N=258 coronary artery revascularization (either PCI or bypass surgery)
N=252 no revascularization (no PCI or bypass surgery)
Primary outcome
Rate of death at a mean follow-up of 2.7 years
22
23
23.0 %
17.3 %
11.5 %
5.8 %
0.0 %
Coronary artery
revascularization
No
revascularization
No significant
difference ↔
No significant difference in the rate of death at a mean follow-up of 2.7 years (22% vs. 23%; RR 0.98, 95% CI 0.7 to 1.37)
Secondary outcomes
No significant difference in the rate of postoperative myocardial infarction, within 30 days of vascular operation (12% vs. 14%; RR 0.86, 95% CI -1 to 2.72)
Conclusion
In patients at increased risk for perioperative cardiac complications and clinically significant coronary artery disease, coronary artery revascularization was not superior to no revascularization with respect to the rate of death at a mean follow-up of 2.7 years.
Reference
McFalls EO, Ward HB, Moritz TE et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004 Dec 30;351(27):2795-804.
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