De Martino et al determined factors affecting long-term mortality after elective repair of an abdominal aortic aneurysm by open or endoscopic methods. The risk for long-term mortality can help decide if the patient is likely to benefit from surgery. The authors are from Dartmouth-Hitchcock Medical Center, the University of Massachusetts and Massachusetts General Hospital.
Patient selection: abdominal aortic aneurysm < 6.5 cm (associated with <10% risk of rupture per year)
Outcome: long-term mortality after abdominal aortic aneurysm repair
Major criteria:
(1) unstable angina or recent acute myocardial infarction
(2) age >= 80 years
(3) oxygen dependent COPD
(4) eGFR < 30 mL per min per 1.73 square meter
Minor criteria:
(1) age 75-70 years
(2) prior myocardial infarction
(3) stable angina
(4) no aspirin therapy
(5) no statin therapy
|
Major Criteria
|
Minor Criteria
|
Diagnosis
|
|
0
|
<= 2
|
low risk
|
|
1
|
<= 2
|
medium risk
|
|
0
|
>= 3
|
medium risk
|
|
>= 2
|
NA
|
high risk
|
|
1
|
>= 3
|
high risk
|
The 5-year survival was 85% for low risk; 69% for medium risk; and 43% for high risk.
A high-risk patient was unlikely to benefit from surgery unless the risk of rupture is very high.
The authors also had a scoring system based on the criteria:
|
Parameter
|
Finding
|
Points
|
|
cardiac history
|
unstable angina or recent acute MI
|
4
|
|
|
stable angina and no MI
|
1
|
|
|
no angina and prior MI
|
1
|
|
|
angina and prior MI
|
2
|
|
|
other
|
0
|
|
age in years
|
< 75 years
|
0
|
|
|
75 to 79 years
|
2
|
|
|
>= 80 years
|
3
|
|
oxygen dependent COPD
|
no
|
0
|
|
|
yes
|
3
|
|
eGFR
|
>= 30 mL per min per 1.73 sq m
|
0
|
|
|
< 30 mL per min per 1.73 sq m
|
3
|
|
aspirin therapy
|
yes
|
0
|
|
|
no
|
1
|
|
statin therapy
|
yes
|
0
|
|
|
no
|
1
|
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• Some of the risk groups have overlapping scores.
• The higher the score the greater the risk of long-term mortality.
