Office of Medical Education, Drexel University, College of Medicine, Philadelphia, Pa.
Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pa.
J Vasc Surg. 2020 Mar;71(3):806-814. doi: 10.1016/j.jvs.2019.05.062. Epub 2019 Aug 27.
Endovascular aneurysm repair (EVAR) has now become the most common operation to treat abdominal aortic aneurysms (AAAs). One of the perceived benefits of EVAR over open AAA repair is reduced incidence of perioperative cardiac complications and mortality. The purpose of this study was to determine risk factors associated with postoperative myocardial infarction (POMI) in patients who have undergone EVAR.
Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for the years 2012 to 2015 in the Participant Use Data File. All patients in the database who underwent EVAR during this time were identified. These patients were then divided into two groups: those with POMI and those without. Bivariate analysis was done for preoperative, intraoperative, and postoperative risk factors, followed by multivariable analysis to determine associations of independent variables with POMI. A risk prediction model for POMI was created to accurately predict incidence of POMI after EVAR.
A total of 7702 patients (81.3% male, 18.7% female) were identified who underwent EVAR from 2011 to 2015. Of these patients, 110 (1.4%) had POMI and 7592 (98.6%) did not. Several risk factors were related to an increased risk of POMI, including dependent functional health status, need for lower extremity revascularization, longer operation time, and ruptured AAA (P < .05, all).On multivariable analysis, the following factors were found to have significant associations with POMI: return to operating room (odds ratio [OR], 1.84; confidence interval [CI], 1.10-3.09; P = .020), ruptured AAA (OR, 1.87; CI, 1.18-2.95; P = .008), pneumonia (OR, 1.94; CI, 1.01-3.73; P = .048), age >80 years (compared with <70 years; OR, 2.30; CI, 1.36-3.86; P = .002), unplanned intubation (OR, 4.07; CI, 2.31-7.18; P < .001), and length of hospital stay >6 days (OR, 8.43; CI, 4.75-14.94; P < .001). The risk prediction model showed that in the presence of all these risk factors, the incidence of POMI was 58.3%. The incidence of cardiac arrest and death was significantly higher for patients with POMI compared with patients without POMI (cardiac arrest, 11.9% vs 1.3%; death, 10.2% vs 1.1%).
In patients who undergo EVAR, the risk of POMI is increased for those who are older, who present with a ruptured AAA, who have pneumonia, who have unplanned intubation, and who have prolonged hospital stay. Patients who suffer from POMI have higher risk of having cardiac arrest and death.
血管内动脉瘤修复术（EVAR）现已成为治疗腹主动脉瘤（AAA）最常见的手术方法。与开放 AAA 修复术相比，EVAR 的一个公认优势是围手术期心脏并发症和死亡率降低。本研究旨在确定接受 EVAR 治疗的患者术后心肌梗死（POMI）的相关危险因素。
从 2012 年至 2015 年期间美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库中的参与者使用数据文件中获取数据。确定在此期间接受 EVAR 的数据库中所有患者。然后将这些患者分为两组：POMI 组和无 POMI 组。对术前、术中、术后危险因素进行双变量分析，然后进行多变量分析，以确定独立变量与 POMI 的相关性。创建 POMI 风险预测模型，以准确预测 EVAR 后 POMI 的发生率。
共确定了 7702 名（81.3%男性，18.7%女性）接受 2011 年至 2015 年 EVAR 的患者。其中 110 名（1.4%）发生 POMI，7592 名（98.6%）未发生。一些危险因素与 POMI 风险增加相关，包括依赖的功能健康状况、下肢血运重建的需要、手术时间延长和破裂的 AAA（均 P <.05）。多变量分析发现，以下因素与 POMI 有显著相关性：返回手术室（比值比 [OR]，1.84；95%置信区间 [CI]，1.10-3.09；P =.020）、破裂的 AAA（OR，1.87；CI，1.18-2.95；P =.008）、肺炎（OR，1.94；CI，1.01-3.73；P =.048）、年龄>80 岁（与<70 岁相比；OR，2.30；CI，1.36-3.86；P =.002）、计划性插管（OR，4.07；CI，2.31-7.18；P <.001）和住院时间>6 天（OR，8.43；CI，4.75-14.94；P <.001）。风险预测模型显示，在存在所有这些危险因素的情况下，POMI 的发生率为 58.3%。与无 POMI 的患者相比，发生 POMI 的患者发生心肌梗死和死亡的风险明显更高（心肌梗死，11.9%比 1.3%；死亡，10.2%比 1.1%）。
在接受 EVAR 的患者中，年龄较大、患有破裂的 AAA、患有肺炎、计划性插管和住院时间延长的患者发生 POMI 的风险增加。发生 POMI 的患者发生心脏骤停和死亡的风险更高。
