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Does the clinical evaluation of the cardiac status predict outcome in patients with abdominal aortic aneurysms?

K Lachapelle1, A M Graham, J F Symes

  • 1Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, Canada.

Journal of Vascular Surgery
|June 1, 1992
PubMed

Insights

Identifying high-risk patients for cardiac death before abdominal aortic aneurysm repair significantly reduces mortality. A targeted cardiac evaluation strategy proved cost-effective and improved patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Cardiac Risk Assessment

Background:

  • Abdominal aortic aneurysm (AAA) repair carries significant perioperative risks.
  • Cardiac complications are a leading cause of mortality after AAA repair.
  • Cost-effective strategies are needed to optimize patient selection for cardiac evaluation.

Purpose of the Study:

  • To evaluate a cost-effective method for reducing mortality after asymptomatic abdominal aortic aneurysm repair.
  • To stratify patients into risk groups based on clinical evaluation for targeted cardiac work-up.
  • To assess the impact of a risk-stratified approach on cardiac mortality and morbidity.

Main Methods:

  • Retrospective analysis of 146 patients undergoing asymptomatic AAA repair (1986-1990).
  • Patients categorized into three groups based on cardiac history, angina, heart failure, and ECG findings.
  • Group I: No cardiac history/ischemia. Group II: Mild-moderate cardiac history/ischemia. Group III: Severe heart failure/angina.

Main Results:

  • Overall mortality was 4.8%; cardiac mortality was 3.4%.
  • Group I (low risk) had 1.8% mortality with no cardiac deaths.
  • Group II (intermediate risk) had 9.5% mortality (8% cardiac), significantly higher than Group I (p=0.02).
  • Group III (high risk) had no deaths.
  • Postoperative cardiac morbidity (MI, CHF, tachyarrhythmias) was significantly lower in Group I compared to Group II.

Conclusions:

  • A clinical evaluation-based risk stratification effectively identifies patients at risk for cardiac death after AAA repair.
  • Targeted cardiac work-up for high-risk patients is a cost-effective strategy to reduce perioperative mortality.
  • This approach minimizes unnecessary cardiac investigations in low-risk patients.

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