The Coronary Artery Revascularization Prophylaxis (CARP) Trial: Results and Remaining Controversies

Abstract

A high percentage of patients requiring elective vascular surgery also has indications for coronary artery revascularization, leading to varied opinions as to whether to undertake coronary artery revascularization first, to use risk stratification, or to do no coronary intervention before elective vascular surgery. The Coronary Artery Revascularization Prophylaxis (CARP) Trial determined the long-term benefit of coronary artery revascularization in patients with stable coronary artery disease undergoing elective infra-renal aortic or infra-inguinal vascular surgery. Following application of inclusion/exclusion criteria, those patients who did not require urgent vascular surgery or have significant co-existing conditions underwent cardiac evaluation and angiography. Eligible patients (stenosis >70% in one or more cardiac vessels) were randomized to either undergo coronary revascularization or to have no coronary intervention before vascular surgery; 5859 patients were screened and 4669 were excluded for clinical or other reasons. The remaining 1190 patients underwent coronary angiography following which 680 were excluded for clinical or other reasons. The remaining 510 were randomized to coronary artery revascularization (258) before vascular surgery and no coronary intervention before vascular surgery (252). Coronary artery revascularization neither improves long-term survival nor does it improve short-term outcomes for elective aortic or infra-inguinal vascular surgery.