Shah et al identified risk factors for 1-year mortality following an endovascular repair of the thoracic aorta. These can help to identify patients who may be at high risk following the procedure. The authors are from Duke University.
Patient selection: status post thoracic aorta endovascular repair (thoracic EVAR)
Outcome: 1 year survival
Parameters:
(1) age in years
(2) aortic diameter in centimeters
(3) ASA class
(4) serum creatinine
(5) congestive heart failure (CHF)
|
Parameter |
Finding |
Points |
|
age in years |
<= 75 years |
0 |
|
|
> 75 years |
1 |
|
aortic diameter |
<= 6.5 cm |
0 |
|
|
> 6.5 cm |
1 |
|
ASA class |
Class 1, 2 or 3 |
0 |
|
|
Class 4 |
1 |
|
serum creainine |
<= 1.5 mg/dL |
0 |
|
|
> 1.5 mg/dL |
1 |
|
congestive heart failure |
absent |
0 |
|
|
present |
1 |
where:
• A patient with ASA class 5 is unlikely to have the surgery performed. The perioperative mortality for someone with ASA Class 4 is high. Very few patients undergoing EVAR would be Class 1.
total number of risk factors =
= SUM(points for all 5 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• The 1-year mortality increased with the number of risk factors present.
• About 40% of patients had a 30-day in-hospital mortality.
Performance:
• Age and aortic diamteter are the more important factors with heazard ratios of about 2.2 and p values less than 0.01.
• The remaining factors had hazard radios of 1.8-1.9 with p values of 0.049, 0.05 and 0.08.
Specialty: Cardiology
ICD-10: ,
