title: Anemia is associated with abdominal aortic aneurysm (AAA) size and decreased long-term survival after endovascular AAA repair.
abstract: OBJECTIVE
  Anemia is a common comorbid condition in various inflammatory states and an established predictor of mortality in patients with chronic heart failure, ischemic heart disease, and end-stage renal disease. The present study of patients with abdominal aortic aneurysm (AAA) undergoing endovascular repair (EVAR) assessed the relationships between baseline hemoglobin concentration and AAA size, as well as anemia and long-term survival.
  
  
  METHODS
  Between March 1994 and November 2006, 711 patients (65 women, mean age 75.8 +/- 7.8 years) underwent elective EVAR. Anemia was defined as a hemoglobin level <13 g/dL in men and <12 g/dL in women. Post-EVAR mean follow-up was 48.3 +/- 32.0 months. Association of hemoglobin level with AAA size was assessed with multiple linear regression. Mortality was determined with use of the internet-based Social Security Death Index and the electronic hospital record. Kaplan-Meier survival curves of anemic and nonanemic patient groups were compared by the log-rank method. Multivariable logistic regression models were used to determine the influence of anemia on vital status after EVAR.
  
  
  RESULTS
  A total of 218/711 (30.7%) of AAA patients undergoing EVAR had anemia at baseline. After adjustment for various risk factors, hemoglobin level was inversely related to maximum AAA diameter (beta: - .144, 95%-CI: -1.482 - .322, P = .002). Post-EVAR survival was 65.5% at 5 years and 44.4% at 10 years. In long-term follow-up, survival was significantly lower in patients with anemia as compared to patients without anemia (P < .0001 by log-rank). Baseline hemoglobin levels were independently related to long-term mortality in multivariable Cox regression analysis adjusted for various risk factors (adjusted HR: 0.866, 95% CI: .783 to .958, P = .005). Within this model, statin use (adjusted HR: .517, 95% CI: .308 to .868, P = .013) was independently related to long-term survival, whereas baseline AAA diameter (adjusted HR: 1.022, 95% CI: 1.009 to 1.036, P = .001) was an independently associated with increased mortality.
  
  
  CONCLUSIONS
  Baseline hemoglobin concentration is independently associated with AAA size and reduced long-term survival following EVAR. Thus, the presence or absence of anemia offers a potential refinement of existing risk stratification instruments.
authors.affiliation: Baptist Cardiac and Vascular Institute, Division of Interventional Radiology, Miami, FL 33176, USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Diehm
authors.forename: James F
authors.initials: JF
authors.lastname: Benenati
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Becker
authors.forename: Ramon
authors.initials: R
authors.lastname: Quesada
authors.forename: Athanassios I
authors.initials: AI
authors.lastname: Tsoukas
authors.forename: Barry T
authors.initials: BT
authors.lastname: Katzen
authors.forename: Margaret
authors.initials: M
authors.lastname: Kovacs
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000401:mortality / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015996:Survival Rate
chemical_list: D006454:Hemoglobins