In an attempt to reduce early and late mortality caused by myocardial infarction in patients with aortic aneurysms, coronary arteriography and, when indicated, myocardial revascularization were performed prior to elective aortic reconstruction in 302 patients with infrarenal (289) or thoracoabdominal (13) aortic aneurysms. Severe correctable coronary artery disease (CAD) was identified in 31% of the entire series, whereas severe inoperable CAD was seen in another 5%. Severe, correctable CAD was documented in 42% of patients suspected to have CAD by standard clinical criteria and in 19% of those in whom CAD was not suspected. The overall mortality for 89 cardiac and 227 infrarenal aortic surgical procedures was 4,4%. Fatal complications after infrarenal aneurysm resection occurred in only one (1.6%) of 61 patients who had had preliminary myocardial revascularization.