Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
J Vasc Surg. 2018 Jan;67(1):151-156.e3. doi: 10.1016/j.jvs.2017.05.104. Epub 2017 Aug 12.
The benefit of prophylactic repair of abdominal aortic aneurysms (AAAs) is based on the risk of rupture exceeding the risk of death from other comorbidities. The purpose of this study was to validate a 5-year survival prediction model for patients undergoing elective repair of asymptomatic AAA <6.5 cm to assist in optimal selection of patients.
All patients undergoing elective repair for asymptomatic AAA <6.5 cm (open or endovascular) from 2002 to 2011 were identified from a single institutional database (validation group). We assessed the ability of a prior published Vascular Study Group of New England (VSGNE) model (derivation group) to predict survival in our cohort. The model was assessed for discrimination (concordance index), calibration (calibration slope and calibration in the large), and goodness of fit (score test).
The VSGNE derivation group consisted of 2367 patients (70% endovascular). Major factors associated with survival in the derivation group were age, coronary disease, chronic obstructive pulmonary disease, renal function, and antiplatelet and statin medication use. Our validation group consisted of 1038 patients (59% endovascular). The validation group was slightly older (74 vs 72 years; P < .01) and had a higher proportion of men (76% vs 68%; P < .01). In addition, the derivation group had higher rates of advanced cardiac disease, chronic obstructive pulmonary disease, and baseline creatinine concentration (1.2 vs 1.1 mg/dL; P < .01). Despite slight differences in preoperative patient factors, 5-year survival was similar between validation and derivation groups (75% vs 77%; P = .33). The concordance index of the validation group was identical between derivation and validation groups at 0.659 (95% confidence interval, 0.63-0.69). Our validation calibration in the large value was 1.02 (P = .62, closer to 1 indicating better calibration), calibration slope of 0.84 (95% confidence interval, 0.71-0.97), and score test of P = .57 (>.05 indicating goodness of fit).
Across different populations of patients, assessment of age and level of cardiac, pulmonary, and renal disease can accurately predict 5-year survival in patients with AAA <6.5 cm undergoing repair. This risk prediction model is a valid method to assess mortality risk in determining potential overall survival benefit from elective AAA repair.
预防性修复腹主动脉瘤（AAA）的益处基于破裂风险超过其他合并症死亡风险。本研究的目的是验证一个用于接受择期修复无症状 AAA<6.5cm 的患者的 5 年生存预测模型，以协助最佳选择患者。
从单一机构数据库（验证组）中确定了所有接受择期修复无症状 AAA<6.5cm（开放或血管内）的患者（2002 年至 2011 年）。我们评估了先前发表的血管研究组新英格兰（VSGNE）模型（推导组）在我们队列中预测生存的能力。该模型的评估包括区分度（一致性指数）、校准（校准斜率和大校准）和拟合优度（评分检验）。
VSGNE 推导组包括 2367 例患者（70%血管内）。与推导组生存相关的主要因素包括年龄、冠心病、慢性阻塞性肺疾病、肾功能以及抗血小板和他汀类药物的使用。我们的验证组包括 1038 例患者（59%血管内）。验证组年龄稍大（74 岁比 72 岁；P<0.01），男性比例更高（76%比 68%；P<0.01）。此外，推导组中晚期心脏病、慢性阻塞性肺疾病和基线肌酐浓度的发生率较高（1.2 比 1.1mg/dL；P<0.01）。尽管术前患者因素存在细微差异，但验证组和推导组的 5 年生存率相似（75%比 77%；P=0.33）。验证组的一致性指数在推导组和验证组之间完全相同，为 0.659（95%置信区间，0.63-0.69）。我们的验证大校准值为 1.02（P=0.62，更接近 1 表示更好的校准），校准斜率为 0.84（95%置信区间，0.71-0.97），评分检验 P=0.57（>0.05 表示拟合良好）。
在不同的患者人群中，评估年龄以及心脏、肺部和肾脏疾病的严重程度可以准确预测接受 AAA<6.5cm 修复的患者的 5 年生存率。这种风险预测模型是评估择期 AAA 修复潜在总体生存获益的死亡率风险的有效方法。
