Risk factors for aortic disease combined with coronary artery disease and the significance of preoperative coronary assessment in endovascular aortic repair

Objective The clinical utility of preoperative coronary assessment in patients undergoing endovascular aortic repair (EVAR) remains uncertain. This study aims to identify risk factors for aortic disease combined with coronary artery disease (CAD) and evaluate the impact of preoperative coronary assessment on in-hospital adverse events. Methods We conducted a single-center retrospective cohort study of patients undergoing elective EVAR at Beijing Anzhen Hospital (January 2021–June 2023). Participants were stratified by coronary assessment status within 12 months pre-surgery. Intergroup comparisons used two-independent samples t -tests and chi-square tests. In-hospital adverse events were a composite endpoint (all-cause mortality, acute myocardial infarction, acute heart failure, stroke, acute kidney injury, bleeding events, endoleak). Univariate logistic regression identified potential risk factors; variables with P < 0.10 were entered into multivariate logistic regression. Results A total of 1,139 patients were included, of whom 385 (33.8%) underwent preoperative coronary assessment. Among assessed patients, 278 with CAD received tailored management, including revascularization or optimized medical therapy. CAD risk varied across aortic disease subtypes ( P = 0.005); abdominal aortic aneurysm (AAA) patients had elevated risk ( OR = 2.113, P = 0.027). Age ( OR = 1.036, P = 0.014) and hyperlipidemia ( OR = 2.652, P < 0.001) were independent CAD risk factors. The non-assessment group had higher in-hospital adverse event rates (6.0% vs. 2.6%, P = 0.012), primarily due to major adverse cardiovascular events (MACE) (3.4% vs. 1.3%, P = 0.035). Preoperative assessment was associated with reduced adverse event risk; non-assessed patients had a 277.9% increased risk ( OR = 3.779, P = 0.002). Conclusion AAA patients have a substantially elevated risk of concurrent CAD. Comprehensive preoperative coronary evaluation before EVAR optimizes medical management and enables appropriate revascularization, enhancing procedural safety and reducing adverse cardiovascular events.