Department of Surgery, Rijnstate, Arnhem, The Netherlands.
Department of Surgery, Rijnstate, Arnhem, The Netherlands; Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
J Vasc Surg. 2022 Dec;76(6):1527-1536.e3. doi: 10.1016/j.jvs.2022.05.018. Epub 2022 Jun 15.
There is a significant cardiac morbidity and mortality after endovascular aneurysm repair (EVAR). However, information about long-term risk of cardiac events after EVAR and potential predictors is lacking. Therefore, the aim of this study was to determine incidence and predictors of major adverse cardiac events (MACE) at 1 and 5 years after elective EVAR for infrarenal abdominal aortic aneurysms.
Baseline, perioperative, and postoperative information of 320 patients was evaluated. The primary outcome was the incidence of MACE after EVAR, which was defined as acute coronary syndrome, unstable angina pectoris, de novo atrial fibrillation, hospitalization for heart failure, mitral valve insufficiency, revascularization (including percutaneous coronary intervention and coronary artery bypass grafting), as well as cardiovascular and noncardiovascular death. Kaplan-Meier analyses were performed to determine incidences of MACE, MACE excluding noncardiovascular death and cardiac events by excluding noncardiovascular and vascular death from MACE. Predictors of MACE were identified using univariate and multivariate binary regression analysis.
Through 1 and 5 years of follow-up after EVAR, freedom from MACE was 89.4% (standard error [SE], 0.018) and 59.8% (SE, 0.033), freedom from MACE excluding noncardiovascular death was 94.7% (SE, 0.013) and 77.5% (SE, 0.030) and freedom from cardiac events was 96.0% (SE, 0.011) and 79.1% (SE, 0.030), respectively. Predictors for MACE within 1 year were American Society of Anesthesiologists (ASA) score of III or IV (odds ratio [OR], 3.17; 95% confidence interval [CI], 1.52-6.59) and larger abdominal aortic diameter (OR, 1.04; 95% CI, 1.01-1.08). A history of atrial fibrillation (OR, 0.14; 95% CI, 0.03-0.60) was a negative predictor factor. Predictors for MACE through 5 years were a history of heart failure (OR, 4.10; 95% CI 1.36-12.32) and valvular heart disease (OR, 2.31; 95% CI, 0.97-5.51), American Society of Anesthesiologists score of 3 or 4 (OR, 1.66; 95% CI, 0.96-2.88), and older age (OR, 1.04; 95% CI, 1.01-1.08).
MACE is a common complication during the first 5 years after elective EVAR. Cardiac diseases at baseline are strong predictors for long-term MACE and potentially helpful in optimizing future postoperative long-term follow-up.
血管内动脉瘤修复（EVAR）后存在显著的心脏发病率和死亡率。然而，关于 EVAR 后心脏事件的长期风险和潜在预测因素的信息仍然缺乏。因此，本研究的目的是确定择期腹主动脉瘤 EVAR 后 1 年和 5 年主要不良心脏事件（MACE）的发生率和预测因素。
评估了 320 名患者的基线、围手术期和术后信息。主要结局是 EVAR 后 MACE 的发生率，定义为急性冠状动脉综合征、不稳定型心绞痛、新发心房颤动、心力衰竭住院、二尖瓣关闭不全、血运重建（包括经皮冠状动脉介入治疗和冠状动脉旁路移植术）以及心血管和非心血管死亡。通过对 MACE 中排除非心血管死亡和心脏事件的非心血管和血管死亡，使用 Kaplan-Meier 分析确定 MACE、MACE 排除非心血管死亡和心脏事件的发生率。使用单变量和多变量二元回归分析确定 MACE 的预测因素。
通过 EVAR 后 1 年和 5 年的随访，无 MACE 的比例分别为 89.4%（标准误差[SE]，0.018）和 59.8%（SE，0.033），无 MACE 排除非心血管死亡的比例分别为 94.7%（SE，0.013）和 77.5%（SE，0.030），无心脏事件的比例分别为 96.0%（SE，0.011）和 79.1%（SE，0.030）。1 年内 MACE 的预测因素为美国麻醉医师协会（ASA）评分 III 或 IV（优势比[OR]，3.17；95%置信区间[CI]，1.52-6.59）和更大的腹主动脉直径（OR，1.04；95% CI，1.01-1.08）。心房颤动史（OR，0.14；95% CI，0.03-0.60）是一个负预测因素。5 年内 MACE 的预测因素为心力衰竭史（OR，4.10；95% CI，1.36-12.32）和瓣膜性心脏病（OR，2.31；95% CI，0.97-5.51）、ASA 评分 3 或 4（OR，1.66；95% CI，0.96-2.88）和年龄较大（OR，1.04；95% CI，1.01-1.08）。
MACE 是择期 EVAR 后 5 年内常见的并发症。基线时的心脏疾病是长期 MACE 的有力预测因素，并有助于优化未来的术后长期随访。
