West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Ann Vasc Surg. 2023 Jan;88:363-372. doi: 10.1016/j.avsg.2022.07.029. Epub 2022 Aug 24.
The aim of this study was to identify risk factors of major adverse cardiac and cerebrovascular events (MACCEs) in octogenarians who received elective endovascular aneurysm repair (EVAR).
Consecutive patients aged ≥ 80 years undergoing elective EVAR from 2009 to 2020 were retrospectively evaluated. The primary outcome was long-term MACCE. All independent risk factors for outcomes were determined by multivariate logistic analysis or Cox regression analysis.
A total of 163 patients were enrolled in this study. The median age was 81 (interquartile range, 80-84) years and 85.9% (140/163) of them were male. MACCE happened in 2.5% (4/163) patients within 30 days. With median follow-up of 28 (interquartile range, 15-46) months, the incidence of long-term MACCE was 26.4% (43/163). Arrhythmia was significantly associated with long-term MACCE (hazard ratio [HR], = 2.64; 95% confidence interval [CI], 1.16-6.03, P = 0.021). Carotid artery disease was found significantly associated with 2-year MACCE (odds ratio [OR], = 6.50, 95% CI, 1.07-39.51, P = 0.042). Besides, we found that arrhythmia and congestive heart failure (CHF) were predictors for overall survival (arrhythmia, HR = 2.56, 95% CI, 1.05-6.28, P = 0.039; CHF, HR = 8.96, 95% CI, 2.12-37.79, P = 0.003).
EVAR in octogenarians had an acceptable perioperative risk and long-term outcome. Considering high risk of 2-year MACCE, intervention strategy should be more cautious for patients with carotid artery disease. Octogenarians with arrhythmia and CHF should receive stricter postoperative management in case of MACCE.
本研究旨在确定接受择期血管内动脉瘤修复术（EVAR）的 80 岁以上患者发生主要心脑血管不良事件（MACCE）的危险因素。
回顾性分析 2009 年至 2020 年连续接受择期 EVAR 的年龄≥80 岁的患者。主要结局是长期 MACCE。通过多变量逻辑分析或 Cox 回归分析确定所有与结局相关的独立危险因素。
本研究共纳入 163 例患者，中位年龄为 81（四分位距，80-84）岁，85.9%（140/163）为男性。30 天内 MACCE 发生率为 2.5%（4/163）。中位随访 28（四分位距，15-46）个月时，长期 MACCE 发生率为 26.4%（43/163）。心律失常与长期 MACCE 显著相关（风险比[HR]，2.64；95%置信区间[CI]，1.16-6.03，P=0.021）。颈动脉疾病与 2 年 MACCE 显著相关（比值比[OR]，6.50；95%CI，1.07-39.51，P=0.042）。此外，我们发现心律失常和充血性心力衰竭（CHF）是总生存率的预测因素（心律失常，HR=2.56；95%CI，1.05-6.28，P=0.039；CHF，HR=8.96；95%CI，2.12-37.79，P=0.003）。
EVAR 在 80 岁以上患者中具有可接受的围手术期风险和长期结局。考虑到 2 年 MACCE 的高风险，对于颈动脉疾病患者，干预策略应更加谨慎。对于有心律失常和 CHF 的 80 岁以上患者，应在发生 MACCE 时进行更严格的术后管理。
