Clinical factors associated with long-term mortality following vascular surgery: Outcomes from The Coronary Artery Revascularization Prophylaxis (CARP) Trial

Edward O. McFalls, Herbert B. Ward, Thomas E. Moritz, Fred Littooy, Steve Santilli, Joseph Rapp, Greg Larsen, Domenic J. Reda

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Background: Preoperative cardiac risks and clinical indications for vascular surgery are both important determinants of outcome following a vascular operation. Using the nonrandomized cohort from the Coronary Artery Revascularization Prophylaxis (CARP) Trial, we analyzed the predictors of outcome based on the presenting vascular problem and prevalence of comorbid conditions and cardiac risks. Methods and Results: Between March 1, 1999 and February 28, 2003, 4414 patients were ineligible for randomization in the CARP Trial and their survival was retrieved through the BIRLS system (the Department of Veterans Affairs Beneficiary Identification and Records Locator Subsystem). Surgical indications were either an abdominal aortic aneurysm (N = 1598) or lower extremity ischemia for claudication (N = 1116), rest pain (N = 670), or tissue loss (N = 1030). Patients were screened for major cardiac risks that included a history of angina, congestive heart failure, myocardial infarction, ventricular arrhythmias, pathological q-waves, and diabetes. The absence of multiple cardiac risks, as the sole reason for exclusion from randomization, occurred in 2314 (52.4%) screened patients and their probability of survival at 2.5-year post-surgery was 0.88. This was better than the survival of the remaining excluded patients (N = 2100), which was 0.75 (P < .0001) and the randomized cohort (N = 462), which was 0.80 (P < .0001). By Cox regression analysis, urgent surgery, congestive heart failure, ventricular arrhythmias and creatinine >3.5 mg/dL were significantly associated with long-term postoperative mortality. Conclusions: Patients without multiple cardiac risks or comorbid conditions have a good outcome following elective vascular surgery. Urgent surgery, creatinine >3.5 mg/dL, congestive heart failure, and ventricular arrhythmias are identifiers of a poor long-term outcome and may justify aggressive strategies for risk-stratification in the postoperative period.

Original languageEnglish (US)
Pages (from-to)694-700
Number of pages7
JournalJournal of vascular surgery
Volume46
Issue number4
DOIs
StatePublished - Oct 2007

Bibliographical note

Funding Information:
This study was supported by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development.

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