Chronic kidney disease classification stratifies mortality risk after elective stent graft repair of the thoracic aorta

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Abstract

Objective: Risk factors for perioperative and late mortality after thoracic endovascular aortic repair (TEVAR) remain ill-defined. In this study, we examined the prognostic significance of chronic kidney disease (CKD), a well-known predictor of death after thoracic aorta open repair, employing a stratification based on CKD stages derived from glomerular filtration rate (GFR) values. Methods: A prospective database was evaluated for 179 consecutive patients electively submitted to TEVAR between 1999 and 2007. Preoperative GFR was estimated by using the Cockcroft-Gault equation. Patient groups were stratified into four quartiles by baseline serum creatinine (SC) and GFR values, with quartile I being the lowest, and quartile IV the highest, and into the five CKD stages in reverse order (I GFR ≥ 90 ml/min/1.73 m2; II 60-89; III 30-59; IV 15-29; V <15). Prognostic significance of preoperative GFR values and CKD stages were investigated by means of univariate and multivariate analyses, and the Kaplan-Meier log-rank method. Results: A primary technical success was achieved in 166 of 179 patients (92.7%), and an initial clinical success in 158 (88.3%). Thirty-day mortality was 5% (nine cases). Paraplegia or paraparesis were observed in 11 (6.1%) patients, and completely resolved in six cases after cerebrospinal fluid drainage. Preoperative GFR quartiles and CKD stages were significant predictors of 30-day mortality (P = .004 and P <.0001 respectively), whereas SC quartiles did not affect the outcome (P = .12). In particular, GFR quartile I (2) was associated with a ten-fold greater risk of perioperative death compared with the other three quartiles (Odds Ratio 11.4, 95% Confidence Interval 2.3-57.0, P = .003). Midterm survival was 88.8% (159 of 179) at a mean follow-up of 35.6 ± 23.7 months. Actuarial survival at 60 months was 57.8%, 81.1%, 92.3%, and 100% for GFR quartiles I to IV respectively (P <.0001), and 0.0%, 66.7%, 59.2%, 88.6%, and 100% (P <.0001) for CKD stage V to I respectively. At univariate analyses, age (P = .019), preoperative SC quartiles (P = .001), GFR quartiles (P = .0002), and CKD stages (P <.0001) were all predictive of mid-term mortality. At multivariate Cox proportional hazards regression analysis, only CKD stages remained independently associated with the outcome (P = .008). Conclusions: GFR is an accurate prognostic predictor in patients submitted to TEVAR. Also, perioperative and midterm mortality directly correlate with the severity of CKD stages, allowing a risk stratification model to be employed both for risk-adjusted preoperative evaluation, and to establish accurate matching criteria for comparative studies.

Original languageEnglish
Pages (from-to)296-301
Number of pages6
JournalJournal of Vascular Surgery
Volume49
Issue number2
DOIs
Publication statusPublished - Feb 2009

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Glomerular Filtration Rate
Thoracic Aorta
Chronic Renal Insufficiency
Stents
Transplants
Mortality
Creatinine
Thorax
Serum
Paraparesis
Survival
Paraplegia
Multivariate Analysis
Odds Ratio
Regression Analysis
Databases
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

@article{e265d322d4c8477a9b6c13e8d76efb74,
title = "Chronic kidney disease classification stratifies mortality risk after elective stent graft repair of the thoracic aorta",
abstract = "Objective: Risk factors for perioperative and late mortality after thoracic endovascular aortic repair (TEVAR) remain ill-defined. In this study, we examined the prognostic significance of chronic kidney disease (CKD), a well-known predictor of death after thoracic aorta open repair, employing a stratification based on CKD stages derived from glomerular filtration rate (GFR) values. Methods: A prospective database was evaluated for 179 consecutive patients electively submitted to TEVAR between 1999 and 2007. Preoperative GFR was estimated by using the Cockcroft-Gault equation. Patient groups were stratified into four quartiles by baseline serum creatinine (SC) and GFR values, with quartile I being the lowest, and quartile IV the highest, and into the five CKD stages in reverse order (I GFR ≥ 90 ml/min/1.73 m2; II 60-89; III 30-59; IV 15-29; V <15). Prognostic significance of preoperative GFR values and CKD stages were investigated by means of univariate and multivariate analyses, and the Kaplan-Meier log-rank method. Results: A primary technical success was achieved in 166 of 179 patients (92.7{\%}), and an initial clinical success in 158 (88.3{\%}). Thirty-day mortality was 5{\%} (nine cases). Paraplegia or paraparesis were observed in 11 (6.1{\%}) patients, and completely resolved in six cases after cerebrospinal fluid drainage. Preoperative GFR quartiles and CKD stages were significant predictors of 30-day mortality (P = .004 and P <.0001 respectively), whereas SC quartiles did not affect the outcome (P = .12). In particular, GFR quartile I (2) was associated with a ten-fold greater risk of perioperative death compared with the other three quartiles (Odds Ratio 11.4, 95{\%} Confidence Interval 2.3-57.0, P = .003). Midterm survival was 88.8{\%} (159 of 179) at a mean follow-up of 35.6 ± 23.7 months. Actuarial survival at 60 months was 57.8{\%}, 81.1{\%}, 92.3{\%}, and 100{\%} for GFR quartiles I to IV respectively (P <.0001), and 0.0{\%}, 66.7{\%}, 59.2{\%}, 88.6{\%}, and 100{\%} (P <.0001) for CKD stage V to I respectively. At univariate analyses, age (P = .019), preoperative SC quartiles (P = .001), GFR quartiles (P = .0002), and CKD stages (P <.0001) were all predictive of mid-term mortality. At multivariate Cox proportional hazards regression analysis, only CKD stages remained independently associated with the outcome (P = .008). Conclusions: GFR is an accurate prognostic predictor in patients submitted to TEVAR. Also, perioperative and midterm mortality directly correlate with the severity of CKD stages, allowing a risk stratification model to be employed both for risk-adjusted preoperative evaluation, and to establish accurate matching criteria for comparative studies.",
author = "Marrocco-Trischitta, {Massimiliano M.} and Germano Melissano and Andrea Kahlberg and Giliola Calori and Francesco Setacci and Roberto Chiesa",
year = "2009",
month = "2",
doi = "10.1016/j.jvs.2008.09.041",
language = "English",
volume = "49",
pages = "296--301",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Chronic kidney disease classification stratifies mortality risk after elective stent graft repair of the thoracic aorta

AU - Marrocco-Trischitta, Massimiliano M.

AU - Melissano, Germano

AU - Kahlberg, Andrea

AU - Calori, Giliola

AU - Setacci, Francesco

AU - Chiesa, Roberto

PY - 2009/2

Y1 - 2009/2

N2 - Objective: Risk factors for perioperative and late mortality after thoracic endovascular aortic repair (TEVAR) remain ill-defined. In this study, we examined the prognostic significance of chronic kidney disease (CKD), a well-known predictor of death after thoracic aorta open repair, employing a stratification based on CKD stages derived from glomerular filtration rate (GFR) values. Methods: A prospective database was evaluated for 179 consecutive patients electively submitted to TEVAR between 1999 and 2007. Preoperative GFR was estimated by using the Cockcroft-Gault equation. Patient groups were stratified into four quartiles by baseline serum creatinine (SC) and GFR values, with quartile I being the lowest, and quartile IV the highest, and into the five CKD stages in reverse order (I GFR ≥ 90 ml/min/1.73 m2; II 60-89; III 30-59; IV 15-29; V <15). Prognostic significance of preoperative GFR values and CKD stages were investigated by means of univariate and multivariate analyses, and the Kaplan-Meier log-rank method. Results: A primary technical success was achieved in 166 of 179 patients (92.7%), and an initial clinical success in 158 (88.3%). Thirty-day mortality was 5% (nine cases). Paraplegia or paraparesis were observed in 11 (6.1%) patients, and completely resolved in six cases after cerebrospinal fluid drainage. Preoperative GFR quartiles and CKD stages were significant predictors of 30-day mortality (P = .004 and P <.0001 respectively), whereas SC quartiles did not affect the outcome (P = .12). In particular, GFR quartile I (2) was associated with a ten-fold greater risk of perioperative death compared with the other three quartiles (Odds Ratio 11.4, 95% Confidence Interval 2.3-57.0, P = .003). Midterm survival was 88.8% (159 of 179) at a mean follow-up of 35.6 ± 23.7 months. Actuarial survival at 60 months was 57.8%, 81.1%, 92.3%, and 100% for GFR quartiles I to IV respectively (P <.0001), and 0.0%, 66.7%, 59.2%, 88.6%, and 100% (P <.0001) for CKD stage V to I respectively. At univariate analyses, age (P = .019), preoperative SC quartiles (P = .001), GFR quartiles (P = .0002), and CKD stages (P <.0001) were all predictive of mid-term mortality. At multivariate Cox proportional hazards regression analysis, only CKD stages remained independently associated with the outcome (P = .008). Conclusions: GFR is an accurate prognostic predictor in patients submitted to TEVAR. Also, perioperative and midterm mortality directly correlate with the severity of CKD stages, allowing a risk stratification model to be employed both for risk-adjusted preoperative evaluation, and to establish accurate matching criteria for comparative studies.

AB - Objective: Risk factors for perioperative and late mortality after thoracic endovascular aortic repair (TEVAR) remain ill-defined. In this study, we examined the prognostic significance of chronic kidney disease (CKD), a well-known predictor of death after thoracic aorta open repair, employing a stratification based on CKD stages derived from glomerular filtration rate (GFR) values. Methods: A prospective database was evaluated for 179 consecutive patients electively submitted to TEVAR between 1999 and 2007. Preoperative GFR was estimated by using the Cockcroft-Gault equation. Patient groups were stratified into four quartiles by baseline serum creatinine (SC) and GFR values, with quartile I being the lowest, and quartile IV the highest, and into the five CKD stages in reverse order (I GFR ≥ 90 ml/min/1.73 m2; II 60-89; III 30-59; IV 15-29; V <15). Prognostic significance of preoperative GFR values and CKD stages were investigated by means of univariate and multivariate analyses, and the Kaplan-Meier log-rank method. Results: A primary technical success was achieved in 166 of 179 patients (92.7%), and an initial clinical success in 158 (88.3%). Thirty-day mortality was 5% (nine cases). Paraplegia or paraparesis were observed in 11 (6.1%) patients, and completely resolved in six cases after cerebrospinal fluid drainage. Preoperative GFR quartiles and CKD stages were significant predictors of 30-day mortality (P = .004 and P <.0001 respectively), whereas SC quartiles did not affect the outcome (P = .12). In particular, GFR quartile I (2) was associated with a ten-fold greater risk of perioperative death compared with the other three quartiles (Odds Ratio 11.4, 95% Confidence Interval 2.3-57.0, P = .003). Midterm survival was 88.8% (159 of 179) at a mean follow-up of 35.6 ± 23.7 months. Actuarial survival at 60 months was 57.8%, 81.1%, 92.3%, and 100% for GFR quartiles I to IV respectively (P <.0001), and 0.0%, 66.7%, 59.2%, 88.6%, and 100% (P <.0001) for CKD stage V to I respectively. At univariate analyses, age (P = .019), preoperative SC quartiles (P = .001), GFR quartiles (P = .0002), and CKD stages (P <.0001) were all predictive of mid-term mortality. At multivariate Cox proportional hazards regression analysis, only CKD stages remained independently associated with the outcome (P = .008). Conclusions: GFR is an accurate prognostic predictor in patients submitted to TEVAR. Also, perioperative and midterm mortality directly correlate with the severity of CKD stages, allowing a risk stratification model to be employed both for risk-adjusted preoperative evaluation, and to establish accurate matching criteria for comparative studies.

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U2 - 10.1016/j.jvs.2008.09.041

DO - 10.1016/j.jvs.2008.09.041

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VL - 49

SP - 296

EP - 301

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 2

ER -