Glasgow Aneurysm Score

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  • Glasgow Aneurysm Score

    1. 1. Glasgow Aneurysm Score predicts survival after endovascular stenting of abdominal aortic aneurysm in patients from the EUROSTAR registry F. Biancari 1, R. Hobo 2 3 *, T. Juvonen 1, on behalf of the EUROSTAR collaborators 1Division of Cardiothoracic and Vascular Surgery, Oulu University Hospital, Oulu, Finland 2EUROSTAR Data Registry Centre, Catharina Hospital, Eindhoven, The Netherlands 3EUROSTAR Secretary, Department of Vascular Surgery, Royal University Hospital, Liverpool, UK British Journal of Surgery, 2006
    2. 2. Glasgow Aneurysm Score predicts survival after endovascular stenting of abdominal aortic aneurysm in patients from the EUROSTAR registry • Glasgow Aneurysm Score (GAS) is a tool to predict postoperative mortality after aneurysma repair • Risk score = [age in years] + [7 points for myocardial disease] + [10 points for cerebrovascular disease] + [14 points for renal disease] • myocardial disease = previously documented myocardial infarction and/or ongoing angina pectoris • cerebrovascular disease = all grades of stroke including transient ischaemic attack (TIA) • renal disease = history of acute or chronic renal failure and/or creatinine level above 133 µmol/l and/or creatinine clearance below 50ml/min
    3. 3. Glasgow Aneurysm Score predicts survival after endovascular stenting of abdominal aortic aneurysm in patients from the EUROSTAR registry Endovascular
    4. 4. Glasgow Aneurysm Score predicts survival after endovascular stenting of abdominal aortic aneurysm in patients from the EUROSTAR registry • EUROpean collaborators on Stent- graft Techniques of abdominal aortic Aneurysm Repair = EUROSTAR • Study period: 5498 patients who undervent endovascular repair (EVAR) enrolled between October 1996 - March 2005
    5. 5. 5498 patients from 160 centers prospectively included with: • non-ruptured, asymptomatic infrarenal, abdominal, aortic aneurysms (AAA) • diameter 40mm or greater • written consent excluded: • withdrawn endograft
    6. 6. pectoris. Cerebrovascular disease refers to all grades of 59·5 per cent of patients, 5·7 per cent had stroke and includes transient ischaemic attack. Renal disease and 18·2 per cent had renal disea disease refers to a history of acute or chronic renal GAS was 78·8 (i.q.r. 71·9–86·4, mean 79· 5498 patients from 160 centers failure and/or a creatinine level above 133 µmol/l and/or creatinine clearance below 50 ml/min, that is a Society for Thirty-day postoperative mortality One hundred and fifty-five patients (2 Table 1 Types of stent-graft used for endovascular aneurysm within 30 days of the initial procedure. U repair showed that preoperative aneurysm diam and GAS (P < 0·001) were associated w Zenith (William Cook) 1916 (34·8) Talent (Medtronic/AVE) 1557 (28·3) risk of death within 30 days. Tertile 3 AneuRx (Medtronic/AVE) 907 (16·5) rates were 1·1 per cent for patients with Excluder (W. L. Gore) 737 (13·4) 74·4, 2·1 per cent for those with a sco Lifepath (Edwards Lifesciences) 119 (2·2) and 83·6, and 5·3 per cent for patients w Powerlink (Endologix) 92 (1·7) Fortron (Cordis/Johnson & Johnson) 77 (1·4) 83·6 (P < 0·001). Multivariate analysis sh EVT (Guidant) 69 (1·3) independently predicted postoperative de Anaconda (Sulzer Vascutek) 24 (0·4) Analysis of the ROC curve showed had an area under the curve of 0·70 (9 William Cook, Bloomington Indiana, USA; Medtronic/AVE, Santa Rosa, dence interval (c.i.) 0·66 to 0·74; s.e. 0·02 California, USA; W. L. Gore, Flagstaff, Arizona, USA; Edwards Lifesciences, Irvine, California USA; Endologix, Irvine, California, USA; predicting postoperative death. Accordin Cordis/Johnson & Johnson, Fort Lauderdale, Florida, USA; Guidant, the best cut-off value was 86·6, which Menlo Park, California, USA; Sulzer Vascutek, Inchinnan, UK. tivity of 56·1 per cent, specificity 76·2 p • Follow-Up scheduled 1,3,6,12,18 and 24 months after surgery, then British Journal of Surgery www.bjs.co.uk annually. Copyright © 2006 British Journal of Surgery Society Ltd Published by John Wiley & Sons Ltd • All the patients had a minimum follow-up of 1 month unless death, aneurysm rupture or conversion to open repair occurred before the first outcome visit.
    7. 7. RESULTS! 5498 patients (94,1% men) median age 72,7 years (i.q.r. 67,3-77,7) median aortic diameter 56mm (i.q.r. 51-63) myocardial disease 59,5% cerebrovascular disease 5,7% median GAS renal disease 18,2% 78,8 points (i.q.r. 71,9-86,4) Thirty-day postoperative mortality: 2 factors: aneurysm diameter / GAS 155 (2,4%) patients died GAS < 74,4: 1,1% tertile mortality Multivariate analysis 74,4 < GAS < 83,6: 2,1 % tertile mortality showed: GAS predicted GAS > 83,6: 5,3% tertile mortality independently postoperative death
    8. 8. RESULTS! Long-term outcome: median follow up was 18 months (i.q.r. 6-24) Overall survival rates were: 91,7% after 1 year 87,1% after 2 years 76,7% after 5 years differed significantly (P < 0.0001) among tertiles Overall rupture rates were: 0,2% after 1 year 0,6% after 2 years 1,7% after 5 years differed not significantly (P < 0.225) between tertiles

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