Document Detail


Clinical factors associated with long-term mortality following vascular surgery: outcomes from the Coronary Artery Revascularization Prophylaxis (CARP) Trial.
MedLine Citation:
PMID:  17903649     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Preoperative cardiac risks and clinical indications for vascular surgery are both important determinants of outcome following a vascular operation. Using the nonrandomized cohort from the Coronary Artery Revascularization Prophylaxis (CARP) Trial, we analyzed the predictors of outcome based on the presenting vascular problem and prevalence of comorbid conditions and cardiac risks.
METHODS AND RESULTS: Between March 1, 1999 and February 28, 2003, 4414 patients were ineligible for randomization in the CARP Trial and their survival was retrieved through the BIRLS system (the Department of Veterans Affairs Beneficiary Identification and Records Locator Subsystem). Surgical indications were either an abdominal aortic aneurysm (N = 1598) or lower extremity ischemia for claudication (N = 1116), rest pain (N = 670), or tissue loss (N = 1030). Patients were screened for major cardiac risks that included a history of angina, congestive heart failure, myocardial infarction, ventricular arrhythmias, pathological q-waves, and diabetes. The absence of multiple cardiac risks, as the sole reason for exclusion from randomization, occurred in 2314 (52.4%) screened patients and their probability of survival at 2.5-year post-surgery was 0.88. This was better than the survival of the remaining excluded patients (N = 2100), which was 0.75 (P < .0001) and the randomized cohort (N = 462), which was 0.80 (P < .0001). By Cox regression analysis, urgent surgery, congestive heart failure, ventricular arrhythmias and creatinine >3.5 mg/dL were significantly associated with long-term postoperative mortality.
CONCLUSIONS: Patients without multiple cardiac risks or comorbid conditions have a good outcome following elective vascular surgery. Urgent surgery, creatinine >3.5 mg/dL, congestive heart failure, and ventricular arrhythmias are identifiers of a poor long-term outcome and may justify aggressive strategies for risk-stratification in the postoperative period.
Authors:
Edward O McFalls; Herbert B Ward; Thomas E Moritz; Fred Littooy; Steve Santilli; Joseph Rapp; Greg Larsen; Domenic J Reda
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  46     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-01     Completed Date:  2007-11-05     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  694-700     Citation Subset:  IM    
Affiliation:
Division of Cardiology, VA Medical Center, Minneapolis, MN 55417, USA. mcfal00l@tc.umn.edu
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MeSH Terms
Descriptor/Qualifier:
Aortic Aneurysm, Abdominal / surgery*
Female
Humans
Ischemia / surgery*
Kaplan-Meier Estimate
Leg / blood supply*
Male
Proportional Hazards Models
Surgical Procedures, Elective
Survival Rate
Vascular Surgical Procedures / mortality*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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