Vázquez Pérez Rocío, Álvarez Marcos Francisco, Tello Díaz Cristina, Bellmunt Montoya Sergi, Fernández-Samos Gutiérrez Rafael, Gil Sala Daniel
Angiology and Vascular Surgery Department, Hospital Universitario de Canarias, La Laguna, Spain.
Angiology and Vascular Surgery Department, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.
Vascular. 2024 Oct;32(5):973-982. doi: 10.1177/17085381231193453. Epub 2023 Aug 1.
Several predictive models exist for estimating the postoperative risks of abdominal aortic aneurysm (AAA) repair, although no particular tool has seen widespread use. We present the results of a multicenter, historic cohort study comparing the predictive capacity of the psoas muscle area (PMA), radiodensity (PMD), and lean muscle area (LMA) as surrogate markers of sarcopenia, over short- and long-term outcomes after AAA repair, compared to the mFI-5 and American Society of Anesthesiologists (ASA) scales.
Retrospective review was conducted of all consecutive AAA elective repair cases (open or endovascular) in three tertiary-care centers from 2014 to 2019. Cross-sectional PMA, PMD, and LMA at the mid-body of the L3 vertebra were measured by two independent operators in the preoperative computed tomography. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff values. Bivariate analysis, logistic regression, and Cox's proportional hazards models were built to examine the relationship between baseline variables and postoperative mortality, long-term mortality, and complications.
596 patients were included (mean age 72.7 ± 8 years, 95.1% male, 66.9% EVAR). Perioperative mortality was 2.3% (EVAR 1.2% vs open repair 4.6%, = .015), and no independent predictors could be identified in the multivariate analysis. Conversely, an age over 74 years old (OR 1.84 95%CI 1.25-2.70), previous heart diseases (OR 1.62 95%CI 1.13-2.32), diabetes mellitus (OR 1.61 95%CI 1.13-2.32), and a PMD value over 66 HU (OR 0.58 95%CI 0.39-0.84) acted as independent predictors of long-term mortality in the Cox's proportional hazards model. Heart diseases (congestive heart failure or coronary artery disease), serum creatinine levels over 1.05 mg/dL, and an aneurysm diameter over 60 mm were independent predictors of major complications.
Surrogate markers of sarcopenia had a poor predictive profile for postoperative mortality after AAA repair in our sample. However, PMD stood out as an independent predictor of long-term mortality. This finding can guide future research and should be confirmed in larger datasets.
目前存在多种用于评估腹主动脉瘤（AAA）修复术后风险的预测模型，但尚无一种特定工具得到广泛应用。我们开展了一项多中心历史性队列研究，比较腰大肌面积（PMA）、放射密度（PMD）和瘦肌肉面积（LMA）作为肌肉减少症替代标志物，在AAA修复术后短期和长期结局方面的预测能力，并与改良脆弱指数-5（mFI-5）和美国麻醉医师协会（ASA）分级进行比较。
对2014年至2019年三个三级医疗中心所有连续的AAA择期修复病例（开放手术或血管腔内修复）进行回顾性分析。术前计算机断层扫描由两名独立操作人员测量L3椎体中部的横断面PMA、PMD和LMA。采用受试者工作特征（ROC）曲线确定最佳截断值。构建双变量分析、逻辑回归和Cox比例风险模型，以检验基线变量与术后死亡率、长期死亡率和并发症之间的关系。
共纳入596例患者（平均年龄72.7±8岁，男性占95.1%，血管腔内修复占66.9%）。围手术期死亡率为2.3%（血管腔内修复为1.2%，开放手术为4.6%，P = 0.015），多变量分析未发现独立预测因素。相反，在Cox比例风险模型中，年龄超过74岁（OR 1.84，95%CI 1.25 - 2.70）、既往有心脏病（OR 1.62，95%CI 1.13 - 2.32）、糖尿病（OR 1.61，95%CI 1.13 - 2.32）以及PMD值超过66 HU（OR 0.58，95%CI 0.39 - 0.84）是长期死亡率的独立预测因素。心脏病（充血性心力衰竭或冠状动脉疾病）、血清肌酐水平超过1.05 mg/dL以及动脉瘤直径超过60 mm是主要并发症的独立预测因素。
在我们的样本中，肌肉减少症替代标志物对AAA修复术后死亡率的预测效果不佳。然而，PMD是长期死亡率的独立预测因素。这一发现可为未来研究提供指导，应在更大的数据集中得到证实。
