Document Detail


Revised Cardiac Risk Index (Lee) and perioperative cardiac events as predictors of long-term mortality in patients undergoing endovascular abdominal aortic aneurysm repair.
MedLine Citation:
PMID:  19556144     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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) > or =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 > or =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 > or =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.
Authors:
Sylvia Archan; Christopher R Roscher; Ronald M Fairman; Lee A Fleisher
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Publication Detail:
Type:  Journal Article     Date:  2009-06-25
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  24     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-05-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  84-90     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA. sylvia.archan@medunigraz.at
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Angioplasty / methods,  statistics & numerical data
Aortic Aneurysm, Abdominal / mortality*,  surgery*
Female
Follow-Up Studies
Humans
Male
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Survival Analysis

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


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