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Predictive Factors for Major Adverse Cardiac and Cerebrovascular Events in Octogenarians after Elective Endovascular Aneurysm Repair

  • Yinzhi Shen
    Affiliations
    West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
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  • Yuhan Qi
    Affiliations
    Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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  • Jichun Zhao
    Correspondence
    Correspondence to: Jichun Zhao, Department of Vascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan, People's Republic of China
    Affiliations
    Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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  • Bin Huang
    Affiliations
    Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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  • Ding Yuan
    Affiliations
    Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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  • Tiehao Wang
    Correspondence
    Correspondence to: Tiehao Wang, Department of Vascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan, People's Republic of China
    Affiliations
    Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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  • Jiarong Wang
    Affiliations
    Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Published:August 23, 2022DOI:https://doi.org/10.1016/j.avsg.2022.07.029

      Background

      The aim of this study was to identify risk factors of major adverse cardiac and cerebrovascular events (MACCEs) in octogenarians who received elective endovascular aneurysm repair (EVAR).

      Methods

      Consecutive patients aged ≥ 80 years undergoing elective EVAR from 2009 to 2020 were retrospectively evaluated. The primary outcome was long-term MACCE. All independent risk factors for outcomes were determined by multivariate logistic analysis or Cox regression analysis.

      Results

      A total of 163 patients were enrolled in this study. The median age was 81 (interquartile range, 80–84) years and 85.9% (140/163) of them were male. MACCE happened in 2.5% (4/163) patients within 30 days. With median follow-up of 28 (interquartile range, 15–46) months, the incidence of long-term MACCE was 26.4% (43/163). Arrhythmia was significantly associated with long-term MACCE (hazard ratio [HR], = 2.64; 95% confidence interval [CI], 1.16–6.03, P = 0.021). Carotid artery disease was found significantly associated with 2-year MACCE (odds ratio [OR], = 6.50, 95% CI, 1.07–39.51, P = 0.042). Besides, we found that arrhythmia and congestive heart failure (CHF) were predictors for overall survival (arrhythmia, HR = 2.56, 95% CI, 1.05–6.28, P = 0.039; CHF, HR = 8.96, 95% CI, 2.12–37.79, P = 0.003).

      Conclusions

      EVAR in octogenarians had an acceptable perioperative risk and long-term outcome. Considering high risk of 2-year MACCE, intervention strategy should be more cautious for patients with carotid artery disease. Octogenarians with arrhythmia and CHF should receive stricter postoperative management in case of MACCE.
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