Long-Term Cardiac Outcome in High-Risk Patients Undergoing Elective Endovascular or Open Infrarenal Abdominal Aortic Aneurysm Repair
Received 8 July 2008; accepted 11 September 2008. published online 15 October 2008.
Abstract
Objectives
To assess long-term outcome of patients at high cardiac risk undergoing endovascular or open AAA repair.
Methods
Patients undergoing open or endovascular infrarenal AAA repair with ≥3 cardiac risk factors and preoperative cardiac stress testing (DSE) at 2 university hospitals were studied. Main outcome was cardiac event free and overall survival. Multivariate Cox regression analysis was used to evaluate the influence of type of AAA repair on long-term outcome.
Results
In 124 patients (55 endovascular, 69 open) the number and type of cardiac risk factors, medication use and DSE results were similar in both groups. In multivariable analysis, adjusting for cardiac risk factors, stress test results, medication use, and propensity score endovascular repair was associated with improved cardiac event free survival (HR 0.54; 95% CI 0.30–0.98) but not with an overall survival benefit (HR 0.73; 95% CI 0.37–1.46). Importantly, statin therapy was associated with both improved overall survival (HR 0.42; 95% CI 0.21–0.83) and cardiac event free survival (HR 0.45; 95% CI 0.23–0.86).
Conclusions
The perioperative cardiac benefit of endovascular AAA repair in high cardiac risk patients is sustained during long-term follow-up provided patients are on optimal medical therapy but it is not associated with improved overall long-term survival.
aDepartment of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
bDepartment of Vascular Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
cDepartment of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
dDepartment of Cardiology, Erasmus MC, Rotterdam, The Netherlands
eDepartment of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
Corresponding author. Department of Vascular Surgery, Room H 921, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel.: +31104639222; fax: +31104634957.
ABSTRACT