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.
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.
aDepartment of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
bDepartment of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
cDepartment of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Correspondence: 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.
ABSTRACT