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 language | English (US) |
|---|---|
| Pages (from-to) | 84-90 |
| Number of pages | 7 |
| Journal | Journal of Cardiothoracic and Vascular Anesthesia |
| Volume | 24 |
| Issue number | 1 |
| DOIs | |
| State | Published - Feb 2010 |
| Externally published | Yes |
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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
Cite this
Revised Cardiac Risk Index (Lee) and Perioperative Cardiac Events as Predictors of Long-term Mortality in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair. / Archan, Sylvia; Roscher, Christopher R.; Fairman, Ronald M.; Fleisher, Lee A.
In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 24, No. 1, 02.2010, p. 84-90.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Revised Cardiac Risk Index (Lee) and Perioperative Cardiac Events as Predictors of Long-term Mortality in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair
AU - Archan, Sylvia
AU - Roscher, Christopher R.
AU - Fairman, Ronald M.
AU - Fleisher, Lee A.
PY - 2010/2
Y1 - 2010/2
N2 - 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.
AB - 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.
KW - abdominal aortic aneurysms
KW - endovascular repair
KW - long-term mortality
KW - perioperative cardiac events
KW - predictors
UR - http://www.scopus.com/inward/record.url?scp=74649087259&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=74649087259&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2009.04.003
DO - 10.1053/j.jvca.2009.04.003
M3 - Article
C2 - 19556144
AN - SCOPUS:74649087259
VL - 24
SP - 84
EP - 90
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 1
ER -