b'Scientific Session Abstracts SATURDAY APRIL 20, 2024 9: PREOPERATIVE CARDIAC STRESS TESTING AS A PREDICTOR OF OUTCOMES AFTER THORACIC ENDOVASCULAR AORTIC REPAIRMunir Paul Moacdieh, MD1 , Mohammed Hamouda, MD 1 , Kathryn Pillai, BS 2 , Sina Zarrintan, MD, MPH 1 , , Mahmoud Malas, MD, MHS, RPVI, FACS 11 Department of Surgery, Division of Vascular and Endovascular Surgery,UC San Diego, La Jolla, CA, 2 School of Medicine, California University of Scienceand Medicine, Colton, CABackground: Preoperative cardiac stress testing is a necessary component of thoracic endovascular aortic repair (TEVAR) since vascular patients typically have concomitant coronary artery disease. However, there is a lack of high-quality evidence comparing the effects of positive versus negative preoperative stress testing on TEVAR outcomes. Thus, the purpose of this study is to use a large, multi-center database to compare the predictive effects of preoperative cardiac stress testing on perioperative outcomes in patients undergoing TEVAR.Method: Patients who had undergone TEVAR for any indication from 2011 till 2023 in the Vascular Quality Initiative (VQI) database were identified. A positive stress test was defined as a positive stress EKG, stress echocardiography or nuclear stress scan within 2 years of surgery. Patients with conversion to open repair, no history of cardiac stress testing or no new stress test after coronary intervention were excluded. Outcomes of interest were postoperative stroke, myocardial infarction (MI), spinal cord ischemia (SCI) and 30-day mortality. Mutivariable analysis was performed after adjusting for potential confounders, such as demographics, medical history, surgical history, preoperative medications and pathology, to compare the outcomes.Results: A total of 7,150 patients met our inclusion criteria. There were 1,398 patients (20%) with a positive preoperative stress test. Baseline characteristics are summarized in Table I. Patients with a positive preoperative stress test were more likely to be older, male and have multiple comorbidities. They were also more likely to be on optimal medical management with preoperative dual antiplatelet therapy, statins, ACE inhibitors and beta blockers. After adjusting for potential confounders, positive preoperative stress test was associated with significant increases in the risk of stroke (OR, 1.48; 95% CI, 1.02-2.16; P = .039), MI (OR, 2.06; 95% CI, 1.59-2.67; P .001) and 30-day mortality (OR, 1.44; 95% CI, 1.08-1.91; P = .012) when compared to a negative stress test (Table II).There were no statistically significant increases in SCI (OR, 1.07; 95% CI, 0.68-1.66; P = .778).Conclusion: In this large database study, a positive preoperative cardiac stress test was associated with a significant increased risk of postoperative stroke, MI and 30-day mortality in TEVAR patients despite being on optimal medical management. Further studies are needed to identify modifiable risks that can reduce postoperative complications in patients with positive stress test needing TEVAR.48SOUTHERN CALIFORNIA VASCULAR SURGICAL SOCIETY'