This study states that Stress testing is commonly used before abdominal aortic aneurysm (AAA) repair. Whether stress testing can prevent cardiac events after AAA repair remains unclear. Our objective was to study national stress test utilization rates and to compare perioperative outcomes between high-use centers and low-use centers. We examined patients who underwent elective endovascular (EVR) or open (OPEN) AAA repair in the Vascular Quality Initiative. We measured utilization rates of stress testing across centers and compared the Vascular Study Group of New England Cardiac Risk Index (VSG CRI) score of patients who underwent preoperative stress tests with those who did not. We determined the rate of major adverse cardiac events (MACEs), a composite of perioperative myocardial infarction, stroke, heart failure exacerbation, or death, across centers. We compared MACE and 1-year mortality of centers in the highest quintile of stress test utilization vs those in the lowest quintile. We studied 43,396 EVR patients and 8935 OPEN patients. The median stress test utilization before EVR was 35.9% and varied from 10.2% (5th percentile) to 73.7% (95th percentile), with similar variability for OPEN (median, 57.9%; range, 13.0%-86.0%). 


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