Moderate-to-Severe Preoperative Anemia is Associated with Increased Postoperative Myocardial Infarction and Mortality in Patients Undergoing Transcarotid Artery Revascularization
Chang, Heepeel; Garg, Karan; Veith, Frank J; Basman, Craig; Cho, Jae S; Zeeshan, Muhammad; Mateo, Romeo B; Ebanks, Mikaiel; Rockman, Caron B
BACKGROUND:While preoperative anemia is prevalent among surgical patients, its impact on patients undergoing transcarotid artery revascularization (TCAR) remains poorly understood. This study aims to assess the relationship between the severity of preoperative anemia and outcomes following TCAR. METHODS:A retrospective analysis of the Vascular Quality Initiative database (2016-2021) was performed to identify patients who underwent TCAR for carotid stenosis. Anemia was defined according to World Health Organization guidelines as a hemoglobin (Hb) level <12 g/dL in females and <13 g/dL in males. The severity of anemia was further classified as mild (Hb: 10-11.9 g/dL in females and 11-12.9 g/dL in males) or moderate to severe (Hb < 10 g/dL in females and <11 g/dL in males). Patients were stratified into three cohorts as follows, based on the presence and severity of preoperative anemia: no anemia, mild anemia, and moderate-to-severe anemia. The primary outcome was 30-day mortality. Secondary outcomes included in-hospital stroke, in-hospital death, myocardial infarction (MI), and prolonged postoperative hospitalization (>1 day). Univariable and multivariable logistic regression analyses were conducted to evaluate the association between the severity of preoperative anemia and clinical outcomes. RESULTS:Among 21,648 patients who underwent TCAR, 4,240 (19.8%) had mild anemia, and 3,401 (15.8%) had moderate-to-severe anemia preoperatively. After adjusting for relevant clinical factors and confounders, moderate-to-severe preoperative anemia was associated with significantly increased odds of in-hospital MI (adjusted odds ratio [aOR], 2.39; 95% confidence interval [CI]: 1.53-3.74; P < 0.001), in-hospital death (aOR, 2.65; 95% CI: 1.62-4.34; P < 0.001), and 30-day mortality (aOR, 1.89; 95% CI: 1.32-2.72; P < 0.001) compared to nonanemic patients. Among patients with moderate-to-severe anemia, factors such as a history of chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF), urgent or emergent procedures, and symptomatic carotid stenosis were the strongest predictors of 30-day mortality. In contrast, mild anemia was not associated with increased odds of adverse postoperative outcomes compared to the nonanemic cohort. Preoperative anemia, regardless of severity, was not associated with an increased risk of postoperative stroke following TCAR. However, the severity of preoperative anemia was associated with a stepwise increase in the adjusted odds of prolonged hospitalization (aOR, 1.19 [mild anemia] and 1.57 [moderate-to-severe anemia]). CONCLUSION/CONCLUSIONS:In this multi-institutional retrospective study of patients undergoing TCAR, moderate-to-severe preoperative anemia was independently associated with higher adjusted odds of in-hospital MI, in-hospital death, and 30-day mortality, without an increased risk of postoperative stroke. These findings highlight moderate-to-severe preoperative anemia as a potential independent prognostic marker for identifying high-risk patients. Furthermore, incorporating the severity of anemia into preoperative risk stratification may aid in tailoring perioperative cardiac assessment and optimization strategies, potentially mitigating the risk of adverse outcomes following TCAR.
PMID: 40049547
ISSN: 1615-5947
CID: 5832882
Outcomes and predictors of amputation-free survival in patients undergoing below-knee popliteal-distal bypass
Nwachukwu, Chukwuma; Ratner, Molly; Rockman, Caron; Cayne, Neal; Siracuse, Jeffrey J; Johnson, William; Chang, Heepeel; Jacobowitz, Glenn; Veith, Frank; Shariff, Saadat; Garg, Karan
OBJECTIVE:The infrageniculate popliteal artery is a potential source for inflow in lower extremity bypass surgery in patients with isolated tibial artery disease. The objective of our study was to assess the short- and long-term outcomes of popliteal-distal bypasses using data from the Vascular Quality Initiative (VQI). METHODS:The VQI registry was queried between 2003 and 2021 for patients undergoing surgical revascularizations with the below-knee popliteal artery serving as inflow. Demographics, comorbidities, intraoperative characteristics, and postoperative complications were analyzed. Kaplan-Meier models were used to estimate amputation-free survival, survival, and freedom from amputation. Cox regression analysis was conducted to determine factors associated with major amputation or death. RESULTS:A total of 1884 procedures were analyzed. The mean age of the included patients was 67.7 years. The most frequently observed preoperative comorbidities included insulin-dependent diabetes (52.3%), coronary disease (32.4%), and end-stage renal disease (14.4%). Of all the patients, 670 (35.6%) had a history of ipsilateral endovascular intervention. The procedures were performed for a variety of indications, including tissue loss (84.3%), rest pain (10.9%), and claudication (4.8%). Intraoperatively, the outflow targets were the dorsalis pedis (31.4%), the posterior tibial (24.4%), and the anterior tibial arteries (15.6%). Vein conduit was used in 92.1% of cases. The rate of perioperative myocardial infarction (MI) was 2.4%, and the 30-day mortality was 1.9%. The median length of follow up was 371 days. Amputation-free survival was found to be 85.6% (95% confidence interval [CI], 84.0%-87.2%) at 6 months and 78.6% (95% CI, 76.6%-80.4%) at 12 months. Survival was found to be 93.4% (95% CI, 92.2%-94.5%) at 6 months and 88.6% (95% CI, 87.1%-90.0%) at 12 months. Freedom from amputation was found to be 92.0% (95% CI, 90.7%-93.3%) at 6 months and 89.0% (95% CI, 87.3%-90.4%) at 12 months. Cox regression analysis demonstrated that age greater than 65 years, congestive heart failure, coronary artery disease, and end-stage renal disease were associated with a higher risk of major amputation or death (P < .05). CONCLUSIONS:Below-knee popliteal-distal bypass is a safe and effective approach to treat severe tibial vessel occlusive disease in this challenging patient cohort. Patients exhibited low perioperative complication rates and good amputation-free survival at 1 year.
PMID: 38244642
ISSN: 1097-6809
CID: 5691192
The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia [Editorial]
Patrone, Lorenzo; Pasqui, Edoardo; Conte, Michael S; Farber, Alik; Ferraresi, Roberto; Menard, Matthew; Mills, Joseph L; Rundback, John; Schneider, Peter; Ysa, August; Abhishek, Kumar; Adams, George L; Ahmad, Naseer; Ahmed, Irfan; Alexandrescu, Vlad A; Amor, Max; Alper, David; Andrassy, Martin; Attinger, Christopher; Baadh, Andy; Barakat, Hashem; Biasi, Lukla; Bisdas, Theodosios; Bhatti, Zagum; Blessing, Erwin; Bonaca, Marc P; Bonvini, Stefano; Bosiers, Michel; Bradbury, Andrew W; Beasley, Robert; Behrendt, Christian-Alexander; Brodmann, Marianne; Cabral, Gonzalo; Cancellieri, Roberto; Casini, Andrea; Chandra, Venita; Chisci, Emiliano; Chohan, Omar; Choke, Edward T C; Chong, Patrick F S; Clerici, Giacomo; Coscas, Raphael; Costantino, Mary; Dalla Paola, Luca; Dand, Sabeen; Davies, Robert S M; D'Oria, Mario; Diamantopoulos, Athanasios; Debus, Sebastian; Deloose, Koen; Del Giudice, Costantino; Donato, Gianmarco de; Rubertis, Brian De; Paul De Vries, Jean; Dias, Nuno V; Diaz-Sandoval, Larry; Dick, Florian; Donas, Konstantinos; Dua, Anahita; Fanelli, Fabrizio; Fazzini, Stefano; Foteh, Mazin; Gandini, Roberto; Gargiulo, Mauro; Garriboli, Luca; Genovese, Elizabeth A; Gifford, Edward; Goueffic, Yann; Goverde, Peter; Chand Gupta, Prem; Hinchliffe, Robert; Holden, Andrew; Houlind, Kim C; Howard, Dominic Pj; Huasen, Bella; Isernia, Giacomo; Katsanos, Konstantinos; Katzen, Barry; Kolh, Philippe; Koncar, Igor; Korosoglou, Grigorios; Krishnan, Prakash; Kroencke, Thomas; Krokidis, Miltiadis; Kumarasamy, Arun; Hayes, Paul; Iida, Osamu; Alejandre Lafont, Enrique; Langhoff, Ralf; Lecis, Alexandre; Lessne, Mark; Lichaa, Hady; Lichtenberg, Michael; Lobato, Marta; Lopes, Alice; Loreni, Giorgio; Lucatelli, Pierleone; Madassery, Sreekumar; Maene, Lieven; Manzi, Marco; Maresch, Martin; Santhosh Mathews, Jay; McCaslin, James; Micari, Antonio; Michelagnoli, Stefano; Migliara, Bruno; Morgan, Robert; Morelli, Luis; Morosetti, Daniele; Mouawad, Nicolas; Moxey, Paul; Müller-Hülsbeck, Stefan; Mustapha, Jihad; Nakama, Tatsuya; Nasr, Bahaa; N'dandu, Zola; Neville, Richard; Noory, Elias; Nordanstig, Joakim; Noronen, Katariina; Mariano Palena, Luis; Parlani, Gianbattista; Patel, Ashish S; Patel, Parag; Patel, Rafiuddin; Patel, Sanjay; Pena, Costantino; Perkov, Drazen; Portou, Mark; Pratesi, Giovanni; Rammos, Christos; Reekers, Jim; Riambau, Vicente; Roy, Trisha; Rosenfield, Kenneth; Antonella Ruffino, Maria; Saab, Fadi; Saratzis, Athanasios; Sbarzaglia, Paolo; Schmidt, Andrej; Secemsky, Eric; Siah, Michael; Sillesen, Henrik; Simonte, Gioele; Sirvent, Marc; Sommerset, Jill; Steiner, Sabine; Sakr, Ahmed; Scheinert, Dierk; Shishebor, Mehdi; Spiliopoulos, Stavros; Spinelli, Alessio; Stravoulakis, Konstantinos; Taneva, Gergana; Teso, Desarom; Tessarek, Joerg; Theivacumar, Selva; Thomas, Anish; Thomas, Shannon; Thulasidasan, Narayan; Torsello, Giovanni; Tripathi, Ramesh; Troisi, Nicola; Tummala, Srini; Tummala, Venkat; Twine, Christopher; Uberoi, Raman; Ucci, Alessandro; Valenti, Domenico; van den Berg, Jos; van den Heuvel, Daniel; Van Herzeele, Isabelle; Varcoe, Ramon; Vega de Ceniga, Melina; Veith, Frank J; Venermo, Maarit; Vijaynagar, Badri; Virdee, Sanjiv; Von Stempel, Conrad; Voûte, Michiel T; Khee Yeung, Kak; Zeller, Thomas; Zayed, Hany; Montero Baker, Miguel
PMID: 38523459
ISSN: 1545-1550
CID: 5645462
Positive Preoperative Cardiac Stress Test Associated With Higher Late Mortality in Patients Undergoing Elective Carotid Endarterectomy [Meeting Abstract]
Rokosh, R S; Rockman, C; Jacobowitz, G; Cayne, N; Maldonado, T S; Patel, V I; Siracuse, J J; Veith, F; Chang, H; Garg, K
Objectives: This study compared outcomes in patients with and without preoperative cardiac stress testing undergoing carotid endarterectomy (CEA).
Method(s): Patients in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database who underwent elective carotid revascularization between 2016 and 2019 were included. Patients were analyzed by group based upon whether they underwent cardiac stress testing within two years preceding revascularization without subsequent coronary intervention. Subset analysis was performed comparing outcomes between those with negative and positive results, defined as evidence of ischemia or myocardial infarction (MI). Outcomes of interest were periprocedural MI/stroke, 90-day readmission rates, as well as late-term mortality.
Result(s): We analyzed 14,470 patients who underwent elective CEA. Of these, 5411 (37.4%) underwent preoperative stress testing and 1231 (29.4%) were positive. Comorbidities were significantly higher among patients undergoing CEA with preoperative stress test compared to those without stress testing. For patients with positive stress test undergoing CEA, there was a significant increase in postoperative MI (1.7% vs 0.6%; P <.001) and 90-day readmission rates (19.6% vs 15.8%; P =.003), but no significant change in postoperative stroke or congestive heart failure incidence. In 3-year follow-up after CEA, those with a positive stress test were more likely to undergo coronary artery bypass graft/percutaneous coronary intervention (adjusted hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.42-2.27; P <.0001) and also exhibited a 28% increase in mortality (adjusted HR, 1.28; 95% CI, 1.03-1.58; P =.03) in follow-up compared to those patients with a negative preoperative stress test (Figure). Conversely, those patients with a negative stress test compared to no stress test undergoing CEA experienced a 14% reduction in follow-up mortality (adjusted HR, 0.86; 95% CI, 0.76-0.98; P =.02) despite no difference in in-hospital MI/stroke or follow-up coronary artery bypass graft/percutaneous coronary intervention (adjusted HR, 0.94; 95% CI, 0.78-1.14; P =.53).
Conclusion(s): Our study highlights that cardiac stress testing in appropriately selected patients can facilitate risk stratification and identify patients at higher risk of postoperative adverse cardiac events. Furthermore, judicious patient selection for elective CEA is warranted in patients with a positive preoperative stress test given the increased late mortality. [Formula presented]
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EMBASE:2024650331
ISSN: 1097-6809
CID: 5514382