LAUSR

these schemes in real-world practice, and propose an optimized approach. Methods: We conducted a retrospective analysis of prospectively collected data from our Vascular Quality Initiative database from 2010 to 2017. Open surgical abdominal aortic aneurysm repairs were queried, and adverse cardiac events (myocardial infarction, myocardial injury after noncardiac surgery), new arrhythmia, new congestive heart failure, or cardiovascular death) along with preoperative cardiac testing results were studied. A selective retrospective chart review was then conducted to investigate details not captured in the Vascular Quality Initiative database. Results: We identified 178 open surgical abdominal aortic aneurysm repairs, including 129 elective cases. The majority of elective patients (62%) had preoperative cardiac stress testing. Of these stress tests, 79% were negative, yet 33% of these patients (vs 48% of those with positive stress tests) experienced an adverse cardiac event. Upon further review, many patients who sustained unanticipated cardiac events had irreversible defects on their stress testing or untreated coronary disease on coronary angiography. Conclusions: Preoperative cardiac risk stratification with stress testing was only modestly protective against adverse cardiac events undergoing open abdominal aortic aneurysm repair. Alternative strategies including biomarker use or coronary angiography warrant further real-world investigation.