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Volume 50, Issue 4, Pages 749-754 (October 2009)


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Perioperative asymptomatic cardiac damage after endovascular abdominal aneurysm repair is associated with poor long-term outcome

Parts of this article were presented at the Vascular Annual Meeting 2009, Denver, Colo, June 11-13, 2009.

Tamara A. Winkel, MDa, Olaf Schouten, MDa, Jan-Peter van Kuijk, MDb, Hence J.M. Verhagen, MDa, Jeroen J. Bax, MDc, Don Poldermans, MDbCorresponding Author Informationemail address

Received 12 March 2009; accepted 30 April 2009. published online 29 June 2009.

Background

Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is associated with a decreased incidence of perioperative cardiac complications compared with open repair. However, EVAR is not associated with long-term survival benefit. This study assessed the effect of perioperative asymptomatic cardiac damage after EVAR on long-term prognosis.

Methods

In 220 patients undergoing elective EVAR, routine sampling for levels of cardiac troponin T and electrocardiography (ECG) were performed on days 1, 3, and 7 during the patient's hospital stay. Elevated cardiac troponin T was defined as serum concentrations ≥0.01 ng/mL. Asymptomatic cardiac damage was defined as cardiac troponin T release without symptoms or ECG changes. The median follow-up was 2.9 years. Survival status was obtained by contacting the Office of Civil Registry.

Results

Release of cardiac troponin T (median, 0.08 ng/mL) occurred in 24 of 220 patients, of whom 20 (83%) were asymptomatic and without ECG changes. Patients with asymptomatic cardiac damage had a mortality rate of 85% after 2.9 years vs 51% for patients without perioperative cardiac damage (P < .001). Also after adjustment for clinical risk factors and medication use applying multivariate Cox regression analysis, asymptomatic cardiac damage was associated with a 2.3-fold increased risk for death (95% confidence interval, 1.1-5.1). Statin use was associated with a reduced long-term risk for death (hazard ratio, 0.5; 95% confidence interval, 0.3-0.9).

Conclusion

Asymptomatic cardiac damage in patients undergoing EVAR is associated with poor long-term outcome. Routine perioperative cardiac screening after EVAR might be warranted.

a Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands

b Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands

c Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

Corresponding Author InformationCorrespondence: Prof. Dr. Don Poldermans, Department of Vascular Surgery, Room H 805, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

 This work was supported by unrestricted research grants from ZonMw, the Netherlands Organization for Health Research and Development (#92003340) to Dr Schouten, and Lijf & Leven Foundation, Rotterdam, the Netherlands, to Dr Winkel.

 Competition of interest: none.

PII: S0741-5214(09)01012-X

doi:10.1016/j.jvs.2009.04.069


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