Cardiac risk after elective endovascular repair for infrarenal abdominal aortic aneurysm, results from the Italian Collaborators for EVAR multicenter registry

Objectives: Major adverse cardiac events (MACEs) were common complications after endovascular aortic repair (EVAR) causing significant post-operative morbidity and mortality. The aim of the study was to evaluate the cardiac risk after elective EVAR for uncomplicated non infected infrarenal abdominal aortic aneurysm (iAAA) in a large multicenter cohort. Materials and methods: This is a multicenter, retrospective, financially unsupported physician-initiated observational cohort study conducted by four academic tertiary referral hospitals from January 2018 to March 2021. Baseline, perioperative, and postoperative information of elective EVARs was evaluated. The primary outcome was the incidence of MACE after EVAR, which was defined as acute coronary syndrome, non-ST-elevation myocardial infarction, unstable angina pectoris, de novo atrial fibrillation, hospitalization for heart failure and revascularization as well as cardiovascular death. Secondary outcomes were one year overall survival (all-cause mortality) and freedom from aorta-related mortality. Comparative analysis was conducted between MACE and overall population and univariate and multivariate logistic regression analyses were used to analyse factors associated with the risk of MACE occurrence and early 1-year mortality. Results: The study has enrolled 497 patients (35 females, 7%) with a mean age of 75.3±7.8 years. MACE rate was 6.4% (32/497, events/patients) and the majority of the events were recorded in the post-operative period (24/32, 75%, overall 24/497, 4.8%). One-year survival from all-cause mortality was 94% (95%CI 91-96) and MACEs population showed a significant lower survival estimation rate (Overall-MACEs, 95.8% [95%CI 93-97] - 67.9% [95%CI 47-82], log-rank 41.950, p= .0001). Freedom from aorta-related mortality was 99.3% (95%CI 98-100). The perioperative needing for red blood cells (RBC) transfusions was strongly related to MACEs occurrence (odds ratio [OR] 2.67, 95%CI 1.52-4.68, p= .001) and one-year mortality (hazard ratio [HR] 2.14, 95%CI 1.48-3.09, p= .0001). Conclusion: MACEs represent a common complication in the post-operative and early period after elective EVAR. Blood loss requiring RBC transfusions is associated with increased post-operative MACEs and early mortality, suggesting that all the efforts should be carried out to reduce the bleeding during and after elective interventions.