The potential of simple clinical information and electrocardiogram to predict mortality of primary elective abdominal aortic reconstruction

Abstract

Objective: To assess the importance of simple clinical information to predict mortality after primary elective aortic reconstruction.

Design: Retrospective clinical study.

Materials: Four hundred-three consecutive patients (206 with aortic occlusive disease (51%) and 197 with aneurysmal disease of the abdominal aorta (49%) who underwent primary elective aortic reconstruction during an 8 year study period.

Methods: Eight potential clinical risk variables and six electrocardiogram related risk variables were studied. The predictive value for postoperative mortality was evaluated univariately for all separate variables by calculation of the odds ratio (OR). Determination of the most predictive sets of risk factors was performed by stepwise logistic regression.

Results: Five clinical risk factors showed significant odds ratio's: > 70 years (OR: 4.1), aortic aneurysm (OR: 9.0), myocardial infarction (OR: 8.6), angina pectoris (OR: 4.6), congestive heart failure (OR: 8.1), all p < 0.01. Furthermore, four electrocardiogram related factors showed significant odds ratio's: infarction pattern (OR: 4.3, p = 0.003), ischaemic changes (OR: 6.2, p < 0.001), conductance disturbances (OR: 3.2, p = 0.04), and non-sinus rhythm (OR: 6.2, p = 0.003). Stepwise logistic regression analysis demonstrated that 3 clinical risk factors (aneurysm (OR: 6.1, p = 0.02), myocardial infarction (OR: 3.7, p = 0.01), and congestive heart failure (OR: 5.3, p = 0.006)) contributed significantly to mortality. Addition of any of the electrocardiogram risk factors did not contribute to the prediction of mortality in the presence of these factors.

Conclusions: The patients' history and clinical examination provides the most useful information for further selection of additional cardiac tests before elective primary aortic reconstruction. The additional value of the electrodiogram is somewhat overestimated.