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Cardiac Stress Testing during Workup for Abdominal Aortic Aneurysm Repair Is Not Associated with Improved Patient
Benjamin S Brooke1, Mark R Sarfati1, Yingying Zhang2
1Division of Vascular Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT.
Insights
Cardiac stress testing (CST) for abdominal aortic aneurysms (AAAs) does not improve procedure selection or patient outcomes. Further research is needed to identify which patients benefit from preoperative CST to optimize care.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Medical Decision Making
Background:
- Cardiac stress testing (CST) is frequently used to guide repair decisions for abdominal aortic aneurysms (AAAs).
- The effectiveness of CST in optimizing patient selection and postoperative outcomes for AAA repair remains unclear.
Purpose of the Study:
- To evaluate the association between CST utilization and patient selection for open versus endovascular AAA repair.
- To determine if CST impacts 30-day major adverse cardiac events or mortality (MACE-M) following AAA repair.
Main Methods:
- Retrospective analysis of 3,635 patients undergoing AAA repair from the Vascular Quality Initiative (2010-2012).
- Risk stratification using the Vascular Study Group Cardiac Risk Index (VSG-CRI).
- Inverse probability weighting (IPW) applied to adjust for patient and hospital factors.
Main Results:
- CST was used in 45% of patients; its utilization was not associated with the choice between open or endovascular repair.
- CST was not linked to improved MACE-M outcomes post-AAA repair compared to no CST.
- Abnormal CST results did not significantly influence repair selection or outcomes, even after risk adjustment.
Conclusions:
- Current use of CST in AAA workup is not associated with improved procedural selection or patient outcomes.
- Identifying specific patient subgroups who benefit from preoperative CST is crucial for reducing healthcare utilization and enhancing postoperative results.
Background:
Cardiac stress testing (CST) is commonly used to help determine whether patients with abdominal aortic aneurysms (AAAs) are better candidates for open versus endovascular repair, although it is unknown whether the use of CST achieves its goal of optimizing patient selection and postoperative outcomes.
Methods:
We retrospectively identified 3,635 patients in the Vascular Quality Initiative database (2010-2012) with an AAA ≥ 5.0 cm who were candidates for either open or endovascular AAA repair. The Vascular Study Group Cardiac Risk Index (VSG-CRI) was used to stratify patient risk. We applied generalized estimating equations with inverse probability weighting (IPW) to adjust for patient factors and hospital-level CST utilization to evaluate the effect of CST on composite of 30-day major adverse cardiac events or mortality (MACE-M) following AAA repair.
Results:
CST was utilized in 1,627 (45%) patients during AAA workup, including 451 of 794 (57%) patients selected for open repair and 1,176 of 2,841 (41%) selected for endovascular repair. After IPW, the use of CST was not associated with the probability of patients receiving open versus endovascular repair (OR: 1.00; 95% CI: 0.77-1.32). As compared to patients without CST during AAA workup, adjusted analyses revealed that CST utilization was not associated with improved MACE or mortality outcomes following AAA repair. Among patients receiving CST, an abnormal CST was not significantly associated with selection of open versus endovascular repair or with postoperative outcomes after adjustment for the VSG-CRI score. Similar results were found for patients with either low or high VSG-CRI scores.
Conclusions:
Utilization of CST during workup for AAA is not associated with procedure selection and improved outcomes. Identifying risk factors for individuals who would benefit from preoperative CST before AAA repair will help reduce health care utilization and improve postoperative outcomes.
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