Incidence and predictors of myocardial and kidney injury following endovascular aortic repair: a retrospective cohort study

Abstract

Purpose We performed a retrospective cohort study in patients who underwent endovascular aneurysm repair (EVAR) to determine the incidence and predictors of myocardial injury and acute kidney injury (AKI). Methods We included 267 consecutive patients who underwent EVAR at two tertiary centres in Canada and Poland. The primary outcome was myocardial injury during hospital stay after EVAR defined as a troponin elevation (ultra-sensitivity troponin I Vidas C 19 ngÁL-1 , non-high-sensitivity troponin I Vidas C 0.01 lgÁL-1 , highsensitivity troponin T C 20 ngÁL-1 , non-high-sensitivity troponin T C 0.03 ngÁmL-1). The secondary outcome was AKI defined using the stage 1 of the Acute Kidney Injury Network criteria. Results Myocardial injury occurred in 78/267 patients (29%; 95% confidence interval [CI], 24.1 to 34.9) and with AKI occurring in 25/267 (9.4%; 95% CI, 6.4 to 13.5). In a multivariable analysis, the following variables were associated with an increased risk of myocardial injury: age (adjusted odds ratio [aOR], 1.65 per ten-year increase; 95% CI, 1.09 to 2.49), Revised Cardiac Risk Index score C3 (aOR, 2.85; 95% CI, 1.26 to 6.41), The American Society of Anesthesiology physical status score 4 (aOR, 2.24; 95% CI, 1.12 to 4.47), duration of surgery (aOR, 1.27 per each hour; 95% CI, 1.00 to 1.61), and perioperative drop in hemoglobin (aOR, 3.35 per 10 gÁdL-1 decrease; 95% CI, 1.00 to 11.3). Predictors of AKI were duration of surgery (aOR, 1.72 per hour; 95% CI, 1.36 to 2.17), a preoperative estimated glomerular filtration rate (eGFR) of 30-59 mLÁmin-1 (aOR, 3.82; 95% CI, 1.42 to 10.3), and an eGFR \30 mLÁmin-1 (aOR, 37.0; 95% CI, 7.1 to 193.8). Conclusion Myocardial injury and AKI are frequent during hospital stay after EVAR and warrant further investigation in prospective studies. Résumé Objectif Nous avons réalisé une étude de cohorte rétrospective auprès de patients ayant subi une Electronic supplementary material The online version of this article (

Prevalence and risk factors of myocardial and acute kidney injury following radical nephrectomy with vena cava thrombectomy: a retrospective cohort study

“…Whereas 62.2% of our patients developed tachyarrhythmia which increased oxygen consumption and, thus, myocardial oxygen delivery-consumption mismatch. In line with others [ 41 ], long duration of surgery was also identified as a risk factor of myocardial injury in this cohort. On the other hand, we identified male sex as a protective factor.…”

Major adverse cardiac events after elective infrarenal endovascular aortic aneurysm repair

“…In contrast to our study, previous studies have mainly focussed on individual complications after EVAR, mostly myocardial injury [5][6][7]. To our knowledge no other studies have investigated MACE after EVAR within the range of our definition.…”

“…Identifying predictive factors for cardiac events could be especially helpful to anticipate problems that may occur after EVAR. A few studies investigated multiple predictors for myocardial injury after EVAR, where the only shared predictor was an increasing age [5][6][7] . The occurrence of myocardial injury, comparable with other studies [5][6][7] , was also found to be significantly different between patients aged above and below 75 years in a study, that mainly focussed on the effect of single risk factors, like other studies [8][9][10][11][12][13][14] , on survival after aneurysm repair 8 .…”

“…A few studies investigated multiple predictors for myocardial injury after EVAR, where the only shared predictor was an increasing age [5][6][7] . The occurrence of myocardial injury, comparable with other studies [5][6][7] , was also found to be significantly different between patients aged above and below 75 years in a study, that mainly focussed on the effect of single risk factors, like other studies [8][9][10][11][12][13][14] , on survival after aneurysm repair 8 . Other described predictors for myocardial injury after EVAR included the American Society of Anaesthesiologists (ASA) score IV 7 , diabetes mellitus 7 , different preoperative lab results such as haemoglobin 5 and creatinine 7 , duration of surgery, but also complications during or immediately after surgery 6 .…”

“…Additionally, most available literature focusses on short-term complications only. There is a lack of information about the long-term risk of cardiac events after EVAR and potential predictors [5][6][7] . The aim of this study is to evaluate the risk and predictors of early and late major adverse cardiac events (MACE) after an elective infrarenal EVAR.…”