Factors associated with symptomatic postoperative myocardial infarction after endovascular aneurysm repair

Yang Yang, Erik B. Lehman, Tanya R. Flohr, John Radtka, Faisal Aziz

Research output: Contribution to journalArticle

Abstract

Objective: Endovascular aneurysm repair (EVAR) has now become the most common operation to treat abdominal aortic aneurysms (AAAs). One of the perceived benefits of EVAR over open AAA repair is reduced incidence of perioperative cardiac complications and mortality. The purpose of this study was to determine risk factors associated with postoperative myocardial infarction (POMI) in patients who have undergone EVAR. Methods: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for the years 2012 to 2015 in the Participant Use Data File. All patients in the database who underwent EVAR during this time were identified. These patients were then divided into two groups: those with POMI and those without. Bivariate analysis was done for preoperative, intraoperative, and postoperative risk factors, followed by multivariable analysis to determine associations of independent variables with POMI. A risk prediction model for POMI was created to accurately predict incidence of POMI after EVAR. Results: A total of 7702 patients (81.3% male, 18.7% female) were identified who underwent EVAR from 2011 to 2015. Of these patients, 110 (1.4%) had POMI and 7592 (98.6%) did not. Several risk factors were related to an increased risk of POMI, including dependent functional health status, need for lower extremity revascularization, longer operation time, and ruptured AAA (P <.05, all).On multivariable analysis, the following factors were found to have significant associations with POMI: return to operating room (odds ratio [OR], 1.84; confidence interval [CI], 1.10-3.09; P =.020), ruptured AAA (OR, 1.87; CI, 1.18-2.95; P =.008), pneumonia (OR, 1.94; CI, 1.01-3.73; P =.048), age >80 years (compared with <70 years; OR, 2.30; CI, 1.36-3.86; P =.002), unplanned intubation (OR, 4.07; CI, 2.31-7.18; P <.001), and length of hospital stay >6 days (OR, 8.43; CI, 4.75-14.94; P <.001). The risk prediction model showed that in the presence of all these risk factors, the incidence of POMI was 58.3%. The incidence of cardiac arrest and death was significantly higher for patients with POMI compared with patients without POMI (cardiac arrest, 11.9% vs 1.3%; death, 10.2% vs 1.1%). Conclusions: In patients who undergo EVAR, the risk of POMI is increased for those who are older, who present with a ruptured AAA, who have pneumonia, who have unplanned intubation, and who have prolonged hospital stay. Patients who suffer from POMI have higher risk of having cardiac arrest and death.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Aneurysm
Myocardial Infarction
Abdominal Aortic Aneurysm
Heart Arrest
Aortic Rupture
Incidence
Databases
Information Storage and Retrieval
Quality Improvement
Intubation
Health Status
Lower Extremity
Length of Stay
Pneumonia
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{0cfcdf17a3e14a5c9605e313d19e5b6a,
title = "Factors associated with symptomatic postoperative myocardial infarction after endovascular aneurysm repair",
abstract = "Objective: Endovascular aneurysm repair (EVAR) has now become the most common operation to treat abdominal aortic aneurysms (AAAs). One of the perceived benefits of EVAR over open AAA repair is reduced incidence of perioperative cardiac complications and mortality. The purpose of this study was to determine risk factors associated with postoperative myocardial infarction (POMI) in patients who have undergone EVAR. Methods: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for the years 2012 to 2015 in the Participant Use Data File. All patients in the database who underwent EVAR during this time were identified. These patients were then divided into two groups: those with POMI and those without. Bivariate analysis was done for preoperative, intraoperative, and postoperative risk factors, followed by multivariable analysis to determine associations of independent variables with POMI. A risk prediction model for POMI was created to accurately predict incidence of POMI after EVAR. Results: A total of 7702 patients (81.3{\%} male, 18.7{\%} female) were identified who underwent EVAR from 2011 to 2015. Of these patients, 110 (1.4{\%}) had POMI and 7592 (98.6{\%}) did not. Several risk factors were related to an increased risk of POMI, including dependent functional health status, need for lower extremity revascularization, longer operation time, and ruptured AAA (P <.05, all).On multivariable analysis, the following factors were found to have significant associations with POMI: return to operating room (odds ratio [OR], 1.84; confidence interval [CI], 1.10-3.09; P =.020), ruptured AAA (OR, 1.87; CI, 1.18-2.95; P =.008), pneumonia (OR, 1.94; CI, 1.01-3.73; P =.048), age >80 years (compared with <70 years; OR, 2.30; CI, 1.36-3.86; P =.002), unplanned intubation (OR, 4.07; CI, 2.31-7.18; P <.001), and length of hospital stay >6 days (OR, 8.43; CI, 4.75-14.94; P <.001). The risk prediction model showed that in the presence of all these risk factors, the incidence of POMI was 58.3{\%}. The incidence of cardiac arrest and death was significantly higher for patients with POMI compared with patients without POMI (cardiac arrest, 11.9{\%} vs 1.3{\%}; death, 10.2{\%} vs 1.1{\%}). Conclusions: In patients who undergo EVAR, the risk of POMI is increased for those who are older, who present with a ruptured AAA, who have pneumonia, who have unplanned intubation, and who have prolonged hospital stay. Patients who suffer from POMI have higher risk of having cardiac arrest and death.",
author = "Yang Yang and Lehman, {Erik B.} and Flohr, {Tanya R.} and John Radtka and Faisal Aziz",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jvs.2019.05.062",
language = "English (US)",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
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}

Factors associated with symptomatic postoperative myocardial infarction after endovascular aneurysm repair. / Yang, Yang; Lehman, Erik B.; Flohr, Tanya R.; Radtka, John; Aziz, Faisal.

In: Journal of Vascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors associated with symptomatic postoperative myocardial infarction after endovascular aneurysm repair

AU - Yang, Yang

AU - Lehman, Erik B.

AU - Flohr, Tanya R.

AU - Radtka, John

AU - Aziz, Faisal

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Endovascular aneurysm repair (EVAR) has now become the most common operation to treat abdominal aortic aneurysms (AAAs). One of the perceived benefits of EVAR over open AAA repair is reduced incidence of perioperative cardiac complications and mortality. The purpose of this study was to determine risk factors associated with postoperative myocardial infarction (POMI) in patients who have undergone EVAR. Methods: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for the years 2012 to 2015 in the Participant Use Data File. All patients in the database who underwent EVAR during this time were identified. These patients were then divided into two groups: those with POMI and those without. Bivariate analysis was done for preoperative, intraoperative, and postoperative risk factors, followed by multivariable analysis to determine associations of independent variables with POMI. A risk prediction model for POMI was created to accurately predict incidence of POMI after EVAR. Results: A total of 7702 patients (81.3% male, 18.7% female) were identified who underwent EVAR from 2011 to 2015. Of these patients, 110 (1.4%) had POMI and 7592 (98.6%) did not. Several risk factors were related to an increased risk of POMI, including dependent functional health status, need for lower extremity revascularization, longer operation time, and ruptured AAA (P <.05, all).On multivariable analysis, the following factors were found to have significant associations with POMI: return to operating room (odds ratio [OR], 1.84; confidence interval [CI], 1.10-3.09; P =.020), ruptured AAA (OR, 1.87; CI, 1.18-2.95; P =.008), pneumonia (OR, 1.94; CI, 1.01-3.73; P =.048), age >80 years (compared with <70 years; OR, 2.30; CI, 1.36-3.86; P =.002), unplanned intubation (OR, 4.07; CI, 2.31-7.18; P <.001), and length of hospital stay >6 days (OR, 8.43; CI, 4.75-14.94; P <.001). The risk prediction model showed that in the presence of all these risk factors, the incidence of POMI was 58.3%. The incidence of cardiac arrest and death was significantly higher for patients with POMI compared with patients without POMI (cardiac arrest, 11.9% vs 1.3%; death, 10.2% vs 1.1%). Conclusions: In patients who undergo EVAR, the risk of POMI is increased for those who are older, who present with a ruptured AAA, who have pneumonia, who have unplanned intubation, and who have prolonged hospital stay. Patients who suffer from POMI have higher risk of having cardiac arrest and death.

AB - Objective: Endovascular aneurysm repair (EVAR) has now become the most common operation to treat abdominal aortic aneurysms (AAAs). One of the perceived benefits of EVAR over open AAA repair is reduced incidence of perioperative cardiac complications and mortality. The purpose of this study was to determine risk factors associated with postoperative myocardial infarction (POMI) in patients who have undergone EVAR. Methods: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for the years 2012 to 2015 in the Participant Use Data File. All patients in the database who underwent EVAR during this time were identified. These patients were then divided into two groups: those with POMI and those without. Bivariate analysis was done for preoperative, intraoperative, and postoperative risk factors, followed by multivariable analysis to determine associations of independent variables with POMI. A risk prediction model for POMI was created to accurately predict incidence of POMI after EVAR. Results: A total of 7702 patients (81.3% male, 18.7% female) were identified who underwent EVAR from 2011 to 2015. Of these patients, 110 (1.4%) had POMI and 7592 (98.6%) did not. Several risk factors were related to an increased risk of POMI, including dependent functional health status, need for lower extremity revascularization, longer operation time, and ruptured AAA (P <.05, all).On multivariable analysis, the following factors were found to have significant associations with POMI: return to operating room (odds ratio [OR], 1.84; confidence interval [CI], 1.10-3.09; P =.020), ruptured AAA (OR, 1.87; CI, 1.18-2.95; P =.008), pneumonia (OR, 1.94; CI, 1.01-3.73; P =.048), age >80 years (compared with <70 years; OR, 2.30; CI, 1.36-3.86; P =.002), unplanned intubation (OR, 4.07; CI, 2.31-7.18; P <.001), and length of hospital stay >6 days (OR, 8.43; CI, 4.75-14.94; P <.001). The risk prediction model showed that in the presence of all these risk factors, the incidence of POMI was 58.3%. The incidence of cardiac arrest and death was significantly higher for patients with POMI compared with patients without POMI (cardiac arrest, 11.9% vs 1.3%; death, 10.2% vs 1.1%). Conclusions: In patients who undergo EVAR, the risk of POMI is increased for those who are older, who present with a ruptured AAA, who have pneumonia, who have unplanned intubation, and who have prolonged hospital stay. Patients who suffer from POMI have higher risk of having cardiac arrest and death.

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