Survival After Endovascular Abdominal Aortic Aneurysm Repair in a Population with a Low Incidence of Coronary Artery Disease

Sevilla, Nerea; Clarà, Albert Benet i; Diaz-Duran, Carles; Ruiz-Carmona, Carlos; Ibañez, Sara

doi:10.1007/s00268-015-3377-x

Cited by 5 publications

(2 citation statements)

References 32 publications

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“…12 A review by Sevilla et al also demonstrated how current cancer treatment negatively affects survival after EVAR. 13 These reports are similar but contain slightly different factors from our findings. In contrast to our work, Kashram et al incorporated intra-operative and postoperative factors in their model for late death, whereas we chose risk factors that are available preoperatively to allow patient education and counseling.…”

Section: Discussioncontrasting

confidence: 57%

External validation of a 5-year survival prediction model after elective abdominal aortic aneurysm repair

DeMartino

Huang

Mandrekar³

et al. 2018

Journal of Vascular Surgery

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Objective The benefit of prophylactic repair of abdominal aortic aneurysms (AAAs) is based on the risk of rupture exceeding the risk of death from other comorbidities. The purpose of this study was to validate a 5-year survival prediction model for patients undergoing elective repair of asymptomatic AAA <6.5 cm to assist in optimal selection of patients. Methods All patients undergoing elective repair for asymptomatic AAA <6.5 cm (open or endovascular) from 2002 to 2011 were identified from a single institutional database (validation group). We assessed the ability of a prior published Vascular Study Group of New England (VSGNE) model (derivation group) to predict survival in our cohort. The model was assessed for discrimination (concordance index), calibration (calibration slope and calibration in the large), and goodness of fit (score test). Results The VSGNE derivation group consisted of 2367 patients (70% endovascular). Major factors associated with survival in the derivation group were age, coronary disease, chronic obstructive pulmonary disease, renal function, and antiplatelet and statin medication use. Our validation group consisted of 1038 patients (59% endovascular). The validation group was slightly older (74 vs 72 years; P < .01) and had a higher proportion of men (76% vs 68%; P < .01). In addition, the derivation group had higher rates of advanced cardiac disease, chronic obstructive pulmonary disease, and baseline creatinine concentration (1.2 vs 1.1 mg/dL; P < .01). Despite slight differences in preoperative patient factors, 5-year survival was similar between validation and derivation groups (75% vs 77%; P = .33). The concordance index of the validation group was identical between derivation and validation groups at 0.659 (95% confidence interval, 0.63–0.69). Our validation calibration in the large value was 1.02 (P = .62, closer to 1 indicating better calibration), calibration slope of 0.84 (95% confidence interval, 0.71–0.97), and score test of P = .57 (>.05 indicating goodness of fit). Conclusions Across different populations of patients, assessment of age and level of cardiac, pulmonary, and renal disease can accurately predict 5-year survival in patients with AAA <6.5 cm undergoing repair. This risk prediction model is a valid method to assess mortality risk in determining potential overall survival benefit from elective AAA repair.

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Section: Discussioncontrasting

confidence: 57%

External validation of a 5-year survival prediction model after elective abdominal aortic aneurysm repair

DeMartino

Huang

Mandrekar³

et al. 2018

Journal of Vascular Surgery

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“…In this setting, a proper selection of patients on the basis of their long-term survival has become primordial for decision-making. Over the last years, several studies have studied predictive factors and occasionally proposed scores for estimating the life span of patients with AAA undergoing surgery [3][4][5][6][7][8][9][10][11]. However, their results are heterogeneous and have a limited efficacy in identifying patients who, on the basis of life expectancy, might not be suitable for this intervention.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Inflammatory Biomarkers in 5‐Year Survival After Endovascular Repair of Abdominal Aortic Aneurysms in a Predominantly Male Cohort: Implications for Practice

et al. 2021

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Background Prognostic factors of long-term survival can guide selection of patients for endovascular repair of abdominal aortic aneurysms (EVAR). The aim of this study was to evaluate the relationship between the neutrophilto-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the lymphocyte-to-monocyte ratio (LMR) and the systemic immune-inflammation index (SIII) with survival after EVAR and to assess whether the addition of these biomarkers improved the prediction of survival after surgery. Methods Retrospective analysis of 284 consecutive patients who underwent an EVAR at a single institution. The association between biomarkers and survival was explored using generalized additive models with penalized smoothing splines and multivariate Cox models. C-statistics and continuous net reclassification indexes (c-NRI) were used to assess the improvement in prediction.Results Survival rates at 2 and 5 years were 83.9% and 66.2%, respectively. The predictive score of survival included hemoglobin (HR = 0.849, p = 0.004), statin intake (HR = 0.538, p = 0.004), atrial fibrillation (HR = 2.515, p \ 0.001), heart failure (HR = 2.542, p = 0.017) and the non-revascularized coronary artery disease (HR = 2.163, p = 0.004). Spline analyses showed a linear relationship between survival and NLR, PLR, LMR and SII. After adjusting for the predictive score, there was an independent relationship between survival and NLR (HR = 1.072, p = 0.006), PLR (HR = 1.002, p = 0.014) and SII (HR = 1.000, p = 0.043). However, only the addition of NLR improved moderately the c-NRI. A NLR C 3 was independently associated with lower survival rates at 2-years (HR 1.98; 95% CI 1.07-3.66) and 5-years (HR 1.84, 95% CI 1.22-2.78) of follow-up. Conclusions Most inflammatory biomarkers are linear and independently associated with survival after EVAR, but only the NLR improved moderately the prediction of a survival score. Therefore, a NLR C 3 may be used to identify patients with a low survival rate and help in decision-making.

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The Impact of Atrial Fibrillation on Hospitalization Outcomes of Endovascular Repair of Abdominal Aortic Aneurysm

Elawad

Abugroun

Yendrapalli

et al. 2022

Cardiovascular Revascularization Medicine

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Survival After Endovascular Abdominal Aortic Aneurysm Repair in a Population with a Low Incidence of Coronary Artery Disease

Cited by 5 publications

References 32 publications

External validation of a 5-year survival prediction model after elective abdominal aortic aneurysm repair

External validation of a 5-year survival prediction model after elective abdominal aortic aneurysm repair

Prognostic Value of Inflammatory Biomarkers in 5‐Year Survival After Endovascular Repair of Abdominal Aortic Aneurysms in a Predominantly Male Cohort: Implications for Practice

The Impact of Atrial Fibrillation on Hospitalization Outcomes of Endovascular Repair of Abdominal Aortic Aneurysm

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