title: Factors affecting long-term mortality after endovascular repair of abdominal aortic aneurysms.
abstract: OBJECTIVE
  Endovascular repair of abdominal aortic aneurysms has made considerable advancements with respect to perioperative mortality. However, fewer data are available regarding factors affecting long-term mortality, including the impact of adverse perioperative cardiac events. Perioperative clinical cardiac risk factors are significant predictors of long-term mortality.
  
  
  METHODS
  Retrospective review of a prospective database of 468 patients who underwent endovascular abdominal aortic aneurysm repair from June 3, 1996, to January 31, 2005.
  
  
  METHODS
  Preoperative, intraoperative, and postoperative factors were analyzed using multivariate Cox proportional hazards models to identify statistically significant independent predictors of long-term survival (beyond 30 days and after discharge from the hospital).
  
  
  RESULTS
  The mean age was 74 years, and 90% of the patients were male. Median follow-up was 2.57 years (interquartile range, 0.92-4.06 years). The leading cause of death was cardiac in nature. On multivariate analysis, the number of preoperative clinical cardiac risk factors (P < .001), spending 2 or more days in the intensive care unit (P < .001), and having an ST-segment elevation myocardial infarction (P < .001) were predictors of decreased long-term survival. Of note, having a perioperative non-ST-segment elevation myocardial infarction was not predictive of decreased survival (P = .09).
  
  
  CONCLUSIONS
  Adverse cardiac events are the leading cause of long-term mortality following endovascular repair of abdominal aortic aneurysms. Preoperative clinical cardiac risk factors are significant predictors of long-term mortality, as are a prolonged intensive care unit stay and a perioperative ST-segment elevation myocardial infarction. A perioperative non-ST-segment elevation myocardial infarction did not influence long-term outcome.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA. cdevirgilio@labiomed.org
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
authors.forename: Julie
authors.initials: J
authors.lastname: Tran
authors.forename: Roger
authors.initials: R
authors.lastname: Lewis
authors.forename: Carlos
authors.initials: C
authors.lastname: Donayre
authors.forename: Christine
authors.initials: C
authors.lastname: Dauphine
authors.forename: Rodney
authors.initials: R
authors.lastname: White
authors.forename: Hao
authors.initials: H
authors.lastname: Bui
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000379:methods*