Document Detail


The Glasgow Aneurysm Score as a tool to predict 30-day and 2-year mortality in the patients from the Dutch Randomized Endovascular Aneurysm Management trial.
MedLine Citation:
PMID:  18241749     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Randomized trials have shown that endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) has a lower perioperative mortality than conventional open repair (OR). However, this initial survival advantage disappears after 1 year. To make EVAR cost-effective, patient selection should be improved. The Glasgow Aneurysm Score (GAS) estimates preoperative risk profiles that predict perioperative outcomes after OR. It was recently shown to predict perioperative and long-term mortality after EVAR as well. Here, we applied the GAS to patients from the Dutch Randomized Endovascular Aneurysm Repair (DREAM) trial and compared the applicability of the GAS between open repair and EVAR.
METHODS: A multicenter, randomized trial was conducted to compare OR with EVAR in 345 AAA patients. The GAS was calculated (age + [7 points for myocardial disease] + [10 points for cerebrovascular disease] + [14 points for renal disease]). Optimal cutoff values were determined, and test characteristics for 30-day and 2-year mortality were computed.
RESULTS: The mean GAS was 74.7 +/- 9.3 for OR patients and 75.9 +/- 9.7 for EVAR patients. Two EVAR patients and eight OR patients died < or =30 days postoperatively. The area under the receiver-operator characteristic curve (AUC) was 0.79 for OR patients and 0.87 for EVAR patients. The optimal GAS cutoff value was 75.5 for OR and 86.5 for EVAR. By 2 years postoperatively, 18 patients had died in both the EVAR and the OR patient groups. The AUC was 0.74 for OR patients and 0.78 for EVAR patients. The optimal GAS cutoff value was 74.5 for OR and 77.5 for EVAR.
CONCLUSION: This is the first evaluation of the GAS in a randomized trial comparing AAA patients treated with OR and EVAR. The GAS can be used for prediction of 30-day and 2-year mortality in both OR and EVAR, but in patients that are suitable for both procedures, it is a better predictor for EVAR than for OR patients. In this study, the GAS was most valuable in identifying low-risk patients but not very useful for the identification of the small number of high-risk patients.
Authors:
Annette F Baas; Kristel J M Janssen; Monique Prinssen; Eric Buskens; Jan D Blankensteijn
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  47     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-04     Completed Date:  2008-03-13     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:  277-81     Citation Subset:  IM    
Affiliation:
Julius Center Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. a.f.baas@umcutrecht.nl <a.f.baas@umcutrecht.nl>
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / mortality*,  surgery
Belgium / epidemiology
Blood Vessel Prosthesis Implantation / methods,  mortality*
Cardiomyopathies / complications
Cerebrovascular Disorders / complications
Female
Health Status Indicators*
Humans
Kidney Diseases / complications
Male
Middle Aged
Netherlands / epidemiology
Patient Selection
ROC Curve
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome

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


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