Cardiac risk index as a predictor of long-term survival after repair of abdominal aortic aneurysm.
Life expectancy after aneurysm surgery was analyzed for male patients over the age of 60 years with known risk factors classified by the Goldman cardiac risk index, which has previously been utilized for prediction of immediate perioperative risks of surgery and anesthesia. The preoperative risk factors, Goldman cardiac risk index, and long-term survival rates were tabulated for each of 96 male patients over the age of 60 years who had elective repair of infrarenal abdominal aortic aneurysm. Follow-up data of up to 14 years (mean 4.2 years) was entered into a SurvPak-PC biostatistical software program for construction of Kaplan-Meier survival curves and actuarial life tables to measure differences in survival between groups and for performance of nonparametric analysis (by log rank test) of the influence of preoperative risk factors. The operative mortality rate was 3.1 percent and the 5 year survival rate for the whole group was 61 percent, with a median survival of 8.7 years. Five year survival rates for patients in three age groups (60 to 70 years, 71 to 80 years, and greater than 80 years), when compared with age-matched populations, were 67 percent versus 88 percent, 50 percent versus 73 percent, and 35 percent versus 39 percent, respectively. Patients in Goldman class 1, 2, and 3 or 4 had 5 year survival rates of 79 percent, 53 percent, and 41 percent, respectively. Factors that adversely affected long-term survival were Goldman classes 3 or 4 (median survival 2.1 +/- 0.4 years, p = 0.001), cerebrovascular disease (median survival 1.9 +/- 0.6 years, p = 0.004), history of cardiac disease (median survival 3.2 +/- 0.6 years, p = 0.012), and creatinine concentration greater than 3 mg/100 ml (median survival 3.1 +/- 1.6 years, p = 0.034), whereas Goldman class 2 or the presence of hypertension, pulmonary disease, diabetes mellitus, peripheral vascular disease, and size of the aneurysm, although associated with a shortened length of survival, as independent variables did not reach statistical significance. A combination of any three of these risk factors, however, shortened the survival time markedly (median 1.9 +/- 0.7 years, p = 0.003). We believe that the Goldman cardiac risk index classification correlates with long-term survival in patients undergoing elective aortic surgery.
White
G H
GH
Department of Surgery, VA Wadsworth Medical Center, Los Angeles, California 90073.
Advani
S M
SM
Williams
R A
RA
Wilson
S E
SE
D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D003327:Coronary Disease / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors