Factors affecting long-term mortality after endovascular repair of abdominal aortic aneurysms

Hypothesis: Endovascular repair of abdominal aortic aneurysms has made considerable advancements with respect to perioperative mortality. However, fewer data are available regarding factors affecting long-term mortality, including the impact of adverse perioperative cardiac events. Perioperative clinical cardiac risk factors are significant predictors of long-term mortality. Design, Setting, and Patients: Retrospective review of a prospective database of 468 patients who underwent endovascular abdominal aortic aneurysm repair from June 3, 1996, to January 31, 2005. Main Outcome Measures: Preoperative, intraoperative, and postoperative factors were analyzed using multivariate Cox proportional hazards models to identify statistically significant independent predictors of long-term survival (beyond 30 days and after discharge from the hospital). Results: The mean age was 74 years, and 90% of the patients were male. Median follow-up was 2.57 years (interquartile range, 0.92-4.06 years). The leading cause of death was cardiac in nature. On multivariate analysis, the number of preoperative clinical cardiac risk factors (P<.001), spending 2 or more days in the intensive care unit (P<.001), and having an ST-segment elevation myocardial infarction (P<.001) were predictors of decreased long-term survival. Of note, having a perioperative non-ST-segment elevation myocardial infarction was not predictive of decreased survival (P=.09). Conclusions: Adverse cardiac events are the leading cause of long-term mortality following endovascular repair of abdominal aortic aneurysms. Preoperative clinical cardiac risk factors are significant predictors of long-term mortality, as are a prolonged intensive care unit stay and a perioperative ST-segment elevation myocardial infarction. A perioperative non-ST-segment elevation myocardial infarction did not influence long-term outcome.