Study identifies predictors of MACE in EVAR population

Major cardiac complications for patients undergoing endovascular aortic aneurysm repair occur less than 1% of the time, but they confer increased costs and elevated mortality rates, according to a presentation at the Society for Vascular Surgery Vascular Annual Meeting.

“It is well-established that EVAR is the preferred treatment for [abdominal aortic aneurysm], but postoperative cardiac complications remain a significant cause for morbidity and mortality,” Gerardo Gonzalez-Guardiola, MD, general surgery trainee at NewYork-Presbyterian Hospital, said in an interview with Cardiology Today’s Intervention. “With this in mind, we aimed to further evaluate MACE specifically in the EVAR population with the objective for a more accurate risk prediction model.”

The researchers used the Nationwide Inpatient Sample to retrospectively review 42,547 patients who underwent elective EVAR between 2006 and 2014.

To identify predictors of MACE, researchers analyzed patient and hospital characteristics as well as postoperative complications, length of stay, total cost, discharge disposition and mortality.

Of the patients who electively underwent EVAR, 400 (0.94%) experienced MACE.

Independent predictors of MACE in the cohort were female sex (OR = 1.39; 95% CI, 1.07-1.82), Asian race (OR = 2.12; 95% CI, 1.22-3.71), CAD (OR = 2.06; 95% CI, 1.67-2.55), atrial fibrillation (OR = 1.59; 95% CI, 1.25-2.01), renal failure (OR = 1.99; 95% CI, 1.56-2.54), fluid and electrolyte disorders (OR = 4.54; 95% CI, 3.59-5.73), coagulation deficiencies (OR = 1.95; 95% CI, 1.44-2.64), anemia (OR = 1.35; 95% CI, 1.03-1.76), peripheral vascular disease (OR = 1.43; 95% CI, 1.11-1.84) and malnutrition (OR = 2.77; 95% CI, 1.79-4.31).

There was a lower rate of MACE among smokers (OR = 0.61; 95% CI, 0.49-0.75), according to the researchers.

There was no significant effect on MACE rate among patients with history of MI, prior PCI, CABG or stroke.

There was a higher complication rate for patients who experienced MACE vs. those who did not, including wounds (P < .0001), infections (P < .0001), urinary complications (P = .0109), pulmonary complications (P < .0001), gastrointestinal complications (P = .0467), shock (P < .0001), intraoperative puncture (P < .0001), hemorrhage (P < .0001) and phlebitis (P < .0001), according to the researchers.

Average length of stay for patients with MACE was 9.54 days vs. 2.53 days for those without MACE (P < .0001).

Costs for patients with and without MACE were $53,630 and $26,915, respectively (P < .001).

PAGE BREAK

MACE also conferred higher rates of non-routine discharge (63% vs. 16.49%; P < .001) and mortality (22.5% vs. 0.42%; P < .0001).

“Now, the main objective is to create a better predictive model with the use of data from this study for patients undergoing [EVAR],” Gonzalez-Guardiola told Cardiology Today’s Intervention. “Perhaps these data could help vascular surgeons and cardiologists to determine which patients are at greater risk for cardiac complications after EVAR and determine whether [percutaneous transluminal coronary angioplasty] preoperatively or maximal medical therapy would decrease the morbidity and mortality associated with cardiac events.” – by Dave Quaile

References:

Vuong P, et al. Abstract PC050. Presented at: Society for Vascular Surgery Vascular Annual Meeting; May 31-June 3, 2017; San Diego.

Gonzalez-Guardiola G, et al. J Vasc Surg. 2017;doi:10.1016/j.jvs.2017.03.289.

Disclosures: The researchers report no relevant financial disclosures.