Cardiac medical therapy among patients undergoing abdominal aortic aneurysm repair.
Open abdominal aortic aneurysm (AAA) repair is a common surgical procedure associated with high mortality rates. Our objective was to describe the use of in-hospital cardiac medical therapy among patients undergoing open AAA repair and to examine the effect of perioperative cardiac medical therapy on in-hospital mortality. We examined clinical data and in-hospital medication use among 223 patients who underwent open AAA repair at three North American hospitals, all of which used the Transition resource and cost accounting system. Medication use was described [angiotensin converting enzyme (ACE) inhibitors, aspirin, ss-blockers, and statins] within the cohort at five specific periods of time: presurgery, day of surgery, 1 day after surgery, postsurgery, and discharge. We then performed a matched case-control study where cases were defined as patients who died in-hospital. We compared medication use between cases and controls to assess its impact on in-hospital mortality. Most patients were elderly (mean age 72.5 +/- 9.8 years), 70.4% were male, and in-hospital mortality within the cohort was 10.8%. Medication use in all periods of administration was low. ss-Blocker use was highest among all classes on the day of surgery, with 20.6% of patients undergoing AAA repair receiving the medication. Less than 50% of patients received any of the medications at discharge. After adjusting for baseline differences, perioperative ACE inhibitor use showed a trend toward a protective effect [odds ratio (OR) = 0.09, 95% confidence interval (CI) 0.01-1.31, p = 0.08], and perioperative ss-blocker use was significantly associated with a decrease in mortality (OR = 0.07, 95% CI 0.01-0.87, p = 0.04). Cardiac medical therapy among patients undergoing AAA repair is low throughout all periods of hospitalization. ACE inhibitor and ss-blocker use may be associated with decreased in-hospital mortality.
Kurzencwyg
David
D
Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Filion
Kristian B
KB
Pilote
Louise
L
Nault
Patrice
P
Platt
Robert W
RW
Rahme
Elham
E
Steinmetz
Oren
O
Eisenberg
Mark J
MJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D017544:Aortic Aneurysm, Abdominal / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D001241:Aspirin / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D009656:North America; D016017:Odds Ratio; D019990:Perioperative Care / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin