Major adverse cardiac events after elective infrarenal endovascular aortic aneurysm repair

Diender, Eline; Vermeulen, Jenske J.M.; Pisters, Ron; Schaik, P.M. van; Reijnen, Michel M.P.J.; Holewijn, Suzanne

doi:10.1016/j.jvs.2022.05.018

Cited by 11 publications

(4 citation statements)

References 39 publications

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“…Overall, we included 16,282 patients. The primary outcome of 30-day MACE occurred in 390 (2.4%) patients, which is similar to previous reports 28 . Individual components of 30-day MACE occurred in the following distribution: MI (n=195 [1.2%]), stroke (n=36 [0.2%]), and death (n=202 [1.2%]).…”

Section: Resultssupporting

confidence: 87%

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Predicting Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Using Machine Learning

Verma

Beaton

et al. 2023

Annals of Surgery

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Objective: To develop machine learning (ML) models that predict outcomes following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Summary Background Data: EVAR carries non-negligible peri-operative risks; however, there are no widely used outcome prediction tools. Methods: The National Surgical Quality Improvement Program targeted database was used to identify patients who underwent EVAR for infrarenal AAA between 2011-2021. Input features included 36 pre-operative variables. The primary outcome was 30-day major adverse cardiovascular event (MACE; composite of myocardial infarction, stroke, or death). Data were split into training (70%) and test (30%) sets. Using 10-fold cross-validation, 6 ML models were trained using pre-operative features. The primary model evaluation metric was area under the receiver operating characteristic curve (AUROC). Model robustness was evaluated with calibration plot and Brier score. Subgroup analysis was performed to assess model performance based on age, sex, race, ethnicity, and prior AAA repair. Results: Overall, 16,282 patients were included. The primary outcome of 30-day MACE occurred in 390 (2.4%) patients. Our best performing prediction model was XGBoost, achieving an AUROC (95% CI) of 0.95 (0.94-0.96) compared to logistic regression [0.72 (0.70 – 0.74)]. The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.06. Model performance remained robust on all subgroup analyses. Conclusions: Our newer ML models accurately predict 30-day outcomes following EVAR using pre-operative data and perform better than logistic regression. Our automated algorithms can guide risk mitigation strategies for patients being considered for EVAR.

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Section: Resultssupporting

confidence: 87%

“…The primary outcome of 30-day MACE occurred in 390 (2.4%) patients, which is similar to previous reports. 28…”

Section: Patients and Eventsmentioning

confidence: 99%

Predicting Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Using Machine Learning

Verma

Beaton

et al. 2023

Annals of Surgery

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“…Patients at different risk levels were included under the definition of CAD, including patients previously managed through CABG or coronary angioplasty, and probably, this factor affected the outcomes of this analysis. However, coronary artery disease at baseline has been identified as a strong predictor for MACEs postoperatively in the long term [ 30 ]. Of note, PAD has been recognized as an important factor, maybe of higher prominence than coronary or carotid artery disease, of postoperative cardiovascular complications [ 31 , 32 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience

Ntalouka,

Nana,

Brotis

et al. 2023

JCM

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Background: We evaluated the 30-day postoperative outcome after elective endovascular aneurysm repair (EVAR) and the possible predictors for the 30-day postoperative outcome. Materials: Demographics, medical history, laboratory values, intensive care unit (ICU) admission and 30-day complications classified as major (major adverse cardiovascular events (MACEs), acute kidney injury (AKI) and death of any cause) and minor (postimplantation syndrome (PIS), postoperative delirium (POD), urinary tract infection (UTI) and technical graft failure) were documented (March 2016 to February 2019). Results: We included 322 patients. The majority were managed under general anesthesia (83%) with femoral cutdown (98.1%). Overall, 121 (37.5%) complications, mostly minor (n = 103, 31.9%), were recorded. In total, 11 patients (3.4%) developed MACEs, 5 (1.6%) experienced AKI and 2 (0.6%) died in the ICU. Moreover, 77 patients (23.9%) suffered from PIS, 11 from POD, 11 from UTI and 4 from technical graft failure. The multivariate logistic regression analysis revealed that aneurysm diameter (p = 0.01) and past smoking (p = 0.003) were predictors for complications. PAD was an independent predictor of MACEs (p = 0.003), preoperative neutrophil to lymphocyte ratio (NLR) of AKI (p = 0.003) and past smoking of PIS (p = 0.008), respectively. Conclusions: Our study showed that the 30-day morbidity after EVAR exceeded 35%. However, the majority of complications were minor, and the associated mortality was low. Aneurysm diameter and past smoking were independent predictors for postoperative outcome.

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“…Compared with open repair of abdominal aortic aneurysm, endovascular repair is the less invasive approach because the aorta does not need to be clamped and the procedure can be performed under regional anesthesia, resulting in less sympathetic stimulation, less operative burden on the patient, and less cardiac morbidity and mortality. In a recent study by Diender and collaborators, age, heart failure, and valvular heart disease were identified as predictors of MACE during the 5 years after endovascular repair of the aorta (19). The American Association for Vascular Surgery and the Society for Vascular Surgery Guidelines recommend an individualized approach considering the method of abdominal aortic aneurysm repair and suggest an endovascular approach for high-risk patients (20).…”

Section: Pathophysiologic Changes In Abdominal Aortic Aneurysm Open R...mentioning

confidence: 99%

Cardiac risk assessment in the elective abdominal aortic aneurysm open repair

Đokić,

Jović

2023

Medicinski podmladak

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When indicated, patients with abdominal aortic aneurysm are referred for elective abdominal aortic surgery. Abdominal aortic aneurysm open repair is associated with a high risk for the development of cardiovascular morbidity and mortality. Cardiac risk assessment in abdominal aortic surgery includes evaluation of the likelihood of adverse cardiac events during surgery and/or in the postoperative period. Overall cardiac risk is assessed individually for the patient, taking into account the patient's general condition, cardiac function, patient functional capacity, comorbidity status, and vascular surgery risk. Cardiac morbidity and mortality are several times higher in emergency procedures than in elective abdominal aortic procedures, as well as in surgical procedures compared to endovascular procedures, especially in cases with suprarenal clamping of the aorta. Patients with ischemic heart disease and heart failure are at high risk for adverse cardiac events. Pathophysiologic mechanisms activated intraoperatively by aortic clamping and unclamping, hemodynamic fluctuations, blood loss, coagulopathy, and ischemia-reperfusion injury influence the potential development of perioperative infarction, heart failure, and cardiac arrest in high-risk patients. Assessment of perioperative cardiac function and cardiac risk using leading recommendations and scoring systems before surgery may change the approach to management of high-risk patients with multiple comorbidities and significantly reduce the incidence of perioperative morbidity and mortality.

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Major adverse cardiac events after elective infrarenal endovascular aortic aneurysm repair

Cited by 11 publications

References 39 publications

Predicting Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Using Machine Learning

Predicting Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Using Machine Learning

Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience

Cardiac risk assessment in the elective abdominal aortic aneurysm open repair

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