CARP
Coronary Artery Revascularization Prophylaxis trial
Doente / População Intervenção / Exposição Comparação Desfecho
In 510 patients with stable coronary artery disease scheduled for elective major vascular surgery, prophylactic coronary revascularisation before surgery did not reduce long-term all-cause mortality or postoperative myocardial infarction compared with no preoperative revascularisation.
N
510
Desenho
Open-label RCT
Desfecho
Long-term all-cause mortality (median follow-up 2.7 years)
Relevância
2
Resultado22 % vs 23 % (relative risk 0.98; 95 % CI 0.70–1.37; p=0.92). Postoperative MI within 30 days 12 % vs 14 % (p=0.37). Surgery was delayed by a median 54 vs 18 days.
McFalls EO, Ward HB, Moritz TE, et al. N Engl J Med. 2004;351(27):2795-2804. 10.1056/NEJMoa041905
Discussão e crítica
Highly selected — only 9 % of screened patients were randomised, and left main disease and severe LV dysfunction were excluded — so it says nothing about the highest-risk anatomies. Within stable coronary disease it is definitive and is why routine prophylactic revascularisation before non-cardiac surgery is not recommended.