Ann Surg Treat Res.  2016 Mar;90(3):171-178. 10.4174/astr.2016.90.3.171.

Frequency of concomitant ischemic heart disease and risk factor analysis for an early postoperative myocardial infarction after elective abdominal aortic aneurysm repair

• Han SR
• Kim YW
• Heo SH
• Woo SY
• Park YJ
• Kim DI
• Yang J
• Choi SH
• Kim DK

• KMID: 2155051
• DOI: http://doi.org/10.4174/astr.2016.90.3.171

Abstract

PURPOSE
We aimed to see the frequency of concomitant ischemic heart disease (IHD) in Korean patients with abdominal aortic aneurysm (AAA) and to determine risk factors for an early postoperative acute myocardial infarction (PAMI) after elective open or endovascular AAA repair.
METHODS
We retrospectively reviewed a database of patients who underwent elective AAA repair over the past 11 years. Patients were classified into 3 groups: control group; group I, medical IHD treatment; group II, invasive IHD treatment. Rates of PAMI and mortality at 30 days were compiled and compared between groups according to the type of AAA repair.
RESULTS
Six hundred two elective repairs of infrarenal or juxtarenal AAAs were enrolled in this study. The patients were classified into control group (n = 398, 66.1%), group I (n = 73, 12.1%) and group II (n = 131, 21.8%). PAMI developed more frequently after open surgical repair (OSR) than after endovascular aneurysm repair (EVAR) (5.4% vs. 1.3%, P = 0.012). In OSR patients (n = 373), PAMI developed 2.1% in control group, 18.0% in group I and 7.1% in group II (P < 0.001). In EVAR group (n = 229), PAMI developed 0.6% in control group, 4.3% in group I and 2.2% in group II (P = 0.211). On the multivariable analysis of risk factors of PAMI, PAMI developed more frequently in patients with positive functional stress test.
CONCLUSION
The prevalence of concomitant IHD was 34% in Korean AAA patients. The risk of PAMI was significantly higher after OSR compared to EVAR and in patients with IHD compared to control group. Though we found some risk factors for PAMI, these were not applied to postoperative mortality rate.

Keyword

Abdominal aortic aneurysm; Coronary artery disease; Myocardial infarction; Mortality

MeSH Terms

Aneurysm
Aortic Aneurysm, Abdominal*
Coronary Artery Disease
Exercise Test
Humans
Mortality
Myocardial Infarction*
Myocardial Ischemia*
Prevalence
Retrospective Studies
Risk Factors*

Figure

• 

  Fig. 1 Preoperative cardiac evaluation before elective abdominal aortic aneurysm repair. AAA, abdominal aortic aneurysm; EVAR, endovascular aneurysm repair; OSR, open surgical repair; CK-MB, creatine kinase-myoglobin; T-proBNP, N- terminal pro-brain natriuretic peptide; ACS, acute coronary syndrome; MI, myocardial infarction; CHF, congestive heart failure; VHD, valvular heart disease; MET, metabolic equivalent of the task; SPECT, single-photon emission computerized tomography; CAG, coronary artery angiography; CAD, coronary artery disease; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting. a)The examinations can be overlapped. b)One patient underwent synchronous OSR of AAA and CABG.

• 

  Fig. 2 Comparison of age-adjusted rates of postoperative acute myocardial infarction between groups. OSR, open surgical repair; EVAR, endovascular aneurysm repair; MI, myocardial infarction.

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