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High Risk of Early and Late Cardiovascular Events After Endovascular Aortic Aneurysm Repair

  • Sari Hammo
    Correspondence
    Correspondence to: Sari Hammo, MD, Department of Molecular Medicine and Surgery; Department of Vascular Surgery, Karolinska Institute; Karolinska University Hospital, SE-171 76, Stockholm, Sweden
    Affiliations
    Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden

    Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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  • David Grannas
    Affiliations
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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  • Carl-Magnus Wahlgren
    Affiliations
    Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden

    Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Published:April 25, 2022DOI:https://doi.org/10.1016/j.avsg.2022.04.028

      Background

      The objective of this population-based study was to analyze short- and long-term major adverse cardiovascular events (MACE) after endovascular repair of ruptured or nonruptured thoracic (TAA) and abdominal aortic aneurysms (AAA).

      Methods

      Nationwide retrospective registry study including all patients who underwent endovascular repair (thoracic endovascular aortic repair, TEVAR; abdominal endovascular aneurysm repair, EVAR) for nonruptured/intact (iAAA/iTAA) or ruptured (rAAA/rTAA) abdominal or thoracic aneurysms between 2000 and 2018. The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction (MACE).

      Results

      There were 8,641 patients with TAA and AAA; 634 TEVAR procedures [iTAA 488; rTAA 146], and 8007 EVAR procedures [iAAA 7071; rAAA 936] were performed. MACE incidence at 90-day after TEVAR for iTAA was 10.2% and for rTAA 26.7% [HR 3.02, 95% CI 1.99–4.6]; MACE at 90-day after EVAR for iAAA was 3.7% and for rAAA 26.9% [HR 8.5, 95% CI: 7.16–10.11]. There was a higher cumulative incidence of MACE at 90-day after TEVAR for iTAA compared to EVAR for iAAA [HR 2.82, 95% CI 2.09–3.82] but no difference between the procedures after ruptured aneurysm repair. The median follow-up time was 3.28 years [IQR 1.31–5.94]. There was no long-term difference in MACE between EVAR and TEVAR after ruptured [90 days–5 years: HR 1.14, 95% CI 0.76–1.71; 5–10 years: HR 0.78, 95% CI 0.31–1.96] or intact [90 days–5 years: HR 1.19, 95% CI 0.97–1.46; 5–10 years: HR 0.82, 95% CI 0.56–1.21] aneurysm repair. Female gender had higher long-term incidence of MACE after intact [HR 1.14, 95% CI 1.03–1.27] and ruptured [HR 1.36, 95% CI 1.12–1.65] endovascular aortic aneurysm treatment. After intact aneurysms repair; age [HR 1.05, 95% CI 1.04–1.05], history of angina pectoris [HR 1.19, 95% CI 1.08–1.32], heart failure [HR 1.90, 95% CI 1.69–2.13], and stroke [HR 1.33, 95% CI 1.15–1.53] were associated with MACE.

      Conclusions

      This nationwide cohort study still demonstrated a high risk of early and late cardiovascular events after endovascular aortic repair. Comprehensive strategies for postoperative cardiovascular disease prevention may be needed here.
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