Incidence and predictors of myocardial and kidney injury following endovascular aortic repair: a retrospective cohort study

Abstract

Purpose: We performed a retrospective cohort study in patients who underwent endovascular aneurysm repair (EVAR) to determine the incidence and predictors of myocardial injury and acute kidney injury (AKI).

Methods: We included 267 consecutive patients who underwent EVAR at two tertiary centres in Canada and Poland. The primary outcome was myocardial injury during hospital stay after EVAR defined as a troponin elevation (ultra-sensitivity troponin I Vidas ≥ 19 ng·L^-1, non-high-sensitivity troponin I Vidas ≥ 0.01 µg·L^-1, high-sensitivity troponin T ≥ 20 ng·L^-1, non-high-sensitivity troponin T ≥ 0.03 ng·mL^-1). The secondary outcome was AKI defined using the stage 1 of the Acute Kidney Injury Network criteria.

Results: Myocardial injury occurred in 78/267 patients (29%; 95% confidence interval [CI], 24.1 to 34.9) and with AKI occurring in 25/267 (9.4%; 95% CI, 6.4 to 13.5). In a multivariable analysis, the following variables were associated with an increased risk of myocardial injury: age (adjusted odds ratio [aOR], 1.65 per ten-year increase; 95% CI, 1.09 to 2.49), Revised Cardiac Risk Index score ≥3 (aOR, 2.85; 95% CI, 1.26 to 6.41), The American Society of Anesthesiology physical status score 4 (aOR, 2.24; 95% CI, 1.12 to 4.47), duration of surgery (aOR, 1.27 per each hour; 95% CI, 1.00 to 1.61), and perioperative drop in hemoglobin (aOR, 3.35 per 10 g·dL^-1 decrease; 95% CI, 1.00 to 11.3). Predictors of AKI were duration of surgery (aOR, 1.72 per hour; 95% CI, 1.36 to 2.17), a preoperative estimated glomerular filtration rate (eGFR) of 30-59 mL·min^-1 (aOR, 3.82; 95% CI, 1.42 to 10.3), and an eGFR < 30 mL·min^-1 (aOR, 37.0; 95% CI, 7.1 to 193.8).

Conclusion: Myocardial injury and AKI are frequent during hospital stay after EVAR and warrant further investigation in prospective studies.