709-6 Preoperative Risk Stratification for Geriatric Patients Approaching Vascular Surgery: High Prevalence of Severe Coronary Artery Disease (CAD) Among Patients with Angina or Diabetes Mellitus

Preop evaluation of geriatric pts may identify those at risk for perioperative and long-term cardiac events and a small fraction who could potentially benefit from coronary revascularization prior to vascular surgery (VAS). We have shown that pts with 1 or 2 preop clinical markers (DM, prior MI, Q wave on ECG (QWAVE), angina, age>70 yrs, CHF) are at intermediate risk for postop and late cardiac events and should be considered for non-invasive stress testing to identify those who may benefit from selected preop coronary angiography (ANGIO) and revascularization. To determine if certain high risk subgroups of elderly pts could be identified based on simple clinical features and to compare clinical stratification in elderly vs young pts, we reviewed the results of consecutive ANGlO of 263 elderly pts (≥70 years) and 265 young pts (<60 years) presenting to the Cleveland Clinic Foundation for VAS who had ANGlO≤6 months prior to VAS. Severe stenoses (ANG(+)) was defined: triple vessel (≥50% stenosis in each), 2 vessel (≥50% stenosis in one when the other is <70% LAD), or left main ≥50%; others were called ANG(-).ResultsWith increasing number of clinical markers, a gradient of risk for ANG(+) was seen in the elderly (17%, 55%, 85%, p<0.00001) and the young (14%, 36%, 68%, p<0.00001), for 0, 1–2, and ≤3 markers, respectively. Relative Risk (95% Confidence Intervals) for independent predictors of ANG (+) were: Elderly: Angina 9(4,10), DM 4(2, 8), and QWAVE 3(2, 6). Young: Angina 5(2,10), and QWAVE 6(3,14).ConclusionsThe elderly have an extremely high prevalence of severe CAD with angina and DM alone correlating with a high risk of severe anatomy. To approach this risk associated with a single marker in the elderly, young pts need ≥3 clinical markers