Perioperative and long-term cardiovascular outcomes in patients undergoing endovascular treatment compared with open vascular surgery for abdominal aortic aneurysm or Iliaco-Femoro-Popliteal bypass

Olaf Schouten, Virginie H. Van Waning, M. Kertai, Harm H H Feringa, Jeroen J. Bax, Eric Boersma, Abdou Elhendy, Elena Biagini, Marc R H M Van Sambeek, Hero Van Urk, Don Poldermans

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Abstract

The aim of the present study was to determine the perioperative and long-term cardiac outcomes of patients who underwent elective open or endovascular major vascular surgery corrected for cardiac risk factors and dobutamine stress echocardiography. Consecutive patients who underwent either endovascular (n = 123) or open (n = 560) vascular surgery from 1996 to 2004 at Erasmus Medical Center were enrolled. Patients were screened for cardiac risk factors (advanced age, gender, angina pectoris, myocardial infarction, heart failure, diabetes, stroke, renal failure), cardioprotective medication, and the presence of stress-induced ischemia by dobutamine stress echocardiography. Postoperative data on troponin release and electrocardiography were routinely collected on days 1, 3, and 7 and before discharge. After discharge, patients were regularly screened at the outpatient clinic. The main outcome measures were perioperative and long-term cardiac death and myocardial infarction. The incidence of perioperative cardiac events was significantly less in endovascular-treated patients compared with conventionally treated patients, also after adjustment for clinical risk factors, dobutamine stress echocardiography, and medication (hazard ratio [HR] 0.19, 95% confidence interval [CI] 0.07 to 0.53). In contrast, during long-term follow-up (median 3.8 years, range 0 to 8.4), the incidence of long-term cardiac mortality and myocardial infarction were similar in the 2 groups (HR 0.89, 95% CI 0.52 to 1.52). In conclusion, endovascular stent grafting is associated with a reduced incidence of perioperative complications compared with open vascular surgery. Despite the initial perioperative survival benefit, patients who undergo endovascular surgery remain at high risk for late cardiac events.

Original languageEnglish
Pages (from-to)861-866
Number of pages6
JournalThe American journal of cardiology
Volume96
Issue number6
DOIs
Publication statusPublished - Sep 15 2005

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Abdominal Aortic Aneurysm
Blood Vessels
Stress Echocardiography
Myocardial Infarction
Therapeutics
Incidence
Confidence Intervals
Troponin
Angina Pectoris
Ambulatory Care Facilities
Thoracic Surgery
Stents
Renal Insufficiency
Electrocardiography
Ischemia
Heart Failure
Stroke
Outcome Assessment (Health Care)
Survival
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Perioperative and long-term cardiovascular outcomes in patients undergoing endovascular treatment compared with open vascular surgery for abdominal aortic aneurysm or Iliaco-Femoro-Popliteal bypass. / Schouten, Olaf; Van Waning, Virginie H.; Kertai, M.; Feringa, Harm H H; Bax, Jeroen J.; Boersma, Eric; Elhendy, Abdou; Biagini, Elena; Van Sambeek, Marc R H M; Van Urk, Hero; Poldermans, Don.

In: The American journal of cardiology, Vol. 96, No. 6, 15.09.2005, p. 861-866.

Research output: Contribution to journalArticle

Schouten, Olaf ; Van Waning, Virginie H. ; Kertai, M. ; Feringa, Harm H H ; Bax, Jeroen J. ; Boersma, Eric ; Elhendy, Abdou ; Biagini, Elena ; Van Sambeek, Marc R H M ; Van Urk, Hero ; Poldermans, Don. / Perioperative and long-term cardiovascular outcomes in patients undergoing endovascular treatment compared with open vascular surgery for abdominal aortic aneurysm or Iliaco-Femoro-Popliteal bypass. In: The American journal of cardiology. 2005 ; Vol. 96, No. 6. pp. 861-866.
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abstract = "The aim of the present study was to determine the perioperative and long-term cardiac outcomes of patients who underwent elective open or endovascular major vascular surgery corrected for cardiac risk factors and dobutamine stress echocardiography. Consecutive patients who underwent either endovascular (n = 123) or open (n = 560) vascular surgery from 1996 to 2004 at Erasmus Medical Center were enrolled. Patients were screened for cardiac risk factors (advanced age, gender, angina pectoris, myocardial infarction, heart failure, diabetes, stroke, renal failure), cardioprotective medication, and the presence of stress-induced ischemia by dobutamine stress echocardiography. Postoperative data on troponin release and electrocardiography were routinely collected on days 1, 3, and 7 and before discharge. After discharge, patients were regularly screened at the outpatient clinic. The main outcome measures were perioperative and long-term cardiac death and myocardial infarction. The incidence of perioperative cardiac events was significantly less in endovascular-treated patients compared with conventionally treated patients, also after adjustment for clinical risk factors, dobutamine stress echocardiography, and medication (hazard ratio [HR] 0.19, 95{\%} confidence interval [CI] 0.07 to 0.53). In contrast, during long-term follow-up (median 3.8 years, range 0 to 8.4), the incidence of long-term cardiac mortality and myocardial infarction were similar in the 2 groups (HR 0.89, 95{\%} CI 0.52 to 1.52). In conclusion, endovascular stent grafting is associated with a reduced incidence of perioperative complications compared with open vascular surgery. Despite the initial perioperative survival benefit, patients who undergo endovascular surgery remain at high risk for late cardiac events.",
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AU - Van Waning, Virginie H.

AU - Kertai, M.

AU - Feringa, Harm H H

AU - Bax, Jeroen J.

AU - Boersma, Eric

AU - Elhendy, Abdou

AU - Biagini, Elena

AU - Van Sambeek, Marc R H M

AU - Van Urk, Hero

AU - Poldermans, Don

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