Columbo JA, Demsas F, Wanken ZJ, et al. - Wide variations in the usage of stress testing prior to abdominal aortic aneurysm (AAA) repair was evident across Vascular Quality Initiative centers despite similar patient risk profiles. Centers with high stress test usage did not show reduction in major adverse cardiac events (MACE) or 1-year mortality. Reconsidering value of routine stress testing before AAA repair is advised, and more selective use of stress testing is recommended in the light of findings and associated expenses of widespread testing.

• The Vascular Quality Initiative was used to analyze 43,396 elective endovascular AAA repair (EVAR) patients and 8935 open AAA repair (OAR) patients across 324 centers.

• Across centers, median proportion of stress test usage prior to EVAR was 35.9% and varied from 10.2% (5th percentile) to 73.7% (95th percentile); similar variability was evident for OAR (median, 57.9%; 5th percentile, 13.0%; 95th percentile, 86.0%).

• For the EVAR group, mean VSG-CRI (Vascular Study Group of New England cardiac risk index) was 5.6 ± 2.1 with preoperative stress testing vs 5.4 ± 2.1 without preoperative stress testing; similarly for OAR, the VSG-CRI was 5.1 ± 2.0 vs 4.8 ± 2.1 for those with and without preoperative stress testing, respectively.

• A higher adjusted probability of MACE following both EVAR (odds ratio [OR], 1.78) and OAR (OR, 1.99) but similar 1-year mortality (EVAR: OR, 1.18; OAR: OR, 0.87) was observed in the centers in the highest quintile of stress testing vs centers in the lowest quintile.

• No difference in VSG-CRI was observed between the high stress test centers and low stress test centers.