Revised Cardiac Risk Index (Lee) and Perioperative Cardiac Events as Predictors of Long-term Mortality in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair

Sylvia Archan, Christopher R. Roscher, Ronald M. Fairman, Lee A. Fleisher

Research output: Contribution to journalArticle

Abstract

Objective: To determine if the Revised Cardiac Risk Index (Lee) is useful for stratification of patients by risk of both perioperative cardiac morbidity and long-term all-cause mortality in the setting of endovascular repair of abdominal aortic aneurysms. Design: This study was designed as a retrospective review. Setting: It was conducted at a single academic medical institution. Participants: The analysis included 225 patients with abdominal aortic aneurysms admitted to the authors' institution from 1999 to 2006. Interventions: All patients underwent endovascular aortic aneurysm repair. Measurements and Main Results: Data were collected from medical records, office charts, and physician quality-assurance databases. There were no in-hospital cardiac deaths. The major adverse cardiac event rate in the perioperative period was 6.2%. Long-term all-cause mortality was 23%. Univariate analysis showed that a history of coronary artery disease (CAD) (likelihood ratio [LR] = 8.7, p = 0.023), history of congestive heart failure (LR = 4, p = 0.042), and a Revised Cardiac Risk Index (RCRI) ≥3 (LR = 8.6, p = 0.004) were significant predictors for perioperative major adverse cardiac events. A history of CAD (LR = 10.7, p = 0.002), echocardiographic evidence of myocardial infarction (LR = 8.5, p = 0.006), exercise tolerance of only 1 block (LR = 8.4, p = 0.005), RCRI ≥3 (LR = 5.6, p = 0.022), and perioperative cardiac events (LR = 15.9, p < 0.0001) were significantly associated with long-term all-cause mortality. Perioperative cardiac events remained highly significant in predicting long-term mortality within the RCRI ≥3 subgroup (LR = 6.1, p = 0.019). Conclusions: The results of this study confirm that long-term mortality remains high after endovascular repair of abdominal aortic aneurysms. The Lee index may be a useful tool for stratification of high-risk patients from both a short- and long-term perspective in the setting of endoluminal graft repair.

Original languageEnglish (US)
Pages (from-to)84-90
Number of pages7
JournalJournal of cardiothoracic and vascular anesthesia
Volume24
Issue number1
DOIs
StatePublished - Feb 1 2010

Keywords

  • abdominal aortic aneurysms
  • endovascular repair
  • long-term mortality
  • perioperative cardiac events
  • predictors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Fingerprint Dive into the research topics of 'Revised Cardiac Risk Index (Lee) and Perioperative Cardiac Events as Predictors of Long-term Mortality in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair'. Together they form a unique fingerprint.

  • Cite this