The Glasgow Aneurysm Score as a tool to predict 30-day and 2-year mortality in the patients from the Dutch Randomized Endovascular Aneurysm Management trial
| Autor: | Monique Prinssen, Jan D. Blankensteijn, Kristel J.M. Janssen, Annette F. Baas, Eric Buskens |
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| Přispěvatelé: | Science in Healthy Ageing & healthcaRE (SHARE), Methods in Medicines evaluation & Outcomes research (M2O) |
| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Risk Assessment Severity of Illness Index Endovascular aneurysm repair law.invention Blood Vessel Prosthesis Implantation Aortic aneurysm Aneurysm Belgium Randomized controlled trial Risk Factors law Severity of illness medicine Health Status Indicators Humans Heart lung and circulation [UMCN 2.1] Aged Netherlands Aged 80 and over Cardiovascular diseases [NCEBP 14] business.industry Patient Selection Age Factors Perioperative Middle Aged medicine.disease Abdominal aortic aneurysm Surgery Cerebrovascular Disorders Treatment Outcome ROC Curve Female Kidney Diseases Radiology Cardiomyopathies Cardiology and Cardiovascular Medicine business Aortic Aneurysm Abdominal Abdominal surgery |
| Zdroj: | Journal of Vascular Surgery, 47, 2, pp. 277-81 Journal of Vascular Surgery, 47, 277-81 University of Groningen Journal of Vascular Surgery, 47(2), 277-281. MOSBY-ELSEVIER |
| ISSN: | 0741-5214 |
| Popis: | Contains fulltext : 70846.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Randomized trials have shown that endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) has a lower perioperative mortality than conventional open repair (OR). However, this initial survival advantage disappears after 1 year. To make EVAR cost-effective, patient selection should be improved. The Glasgow Aneurysm Score (GAS) estimates preoperative risk profiles that predict perioperative outcomes after OR. It was recently shown to predict perioperative and long-term mortality after EVAR as well. Here, we applied the GAS to patients from the Dutch Randomized Endovascular Aneurysm Repair (DREAM) trial and compared the applicability of the GAS between open repair and EVAR. METHODS: A multicenter, randomized trial was conducted to compare OR with EVAR in 345 AAA patients. The GAS was calculated (age + [7 points for myocardial disease] + [10 points for cerebrovascular disease] + [14 points for renal disease]). Optimal cutoff values were determined, and test characteristics for 30-day and 2-year mortality were computed. RESULTS: The mean GAS was 74.7 +/- 9.3 for OR patients and 75.9 +/- 9.7 for EVAR patients. Two EVAR patients and eight OR patients died < or =30 days postoperatively. The area under the receiver-operator characteristic curve (AUC) was 0.79 for OR patients and 0.87 for EVAR patients. The optimal GAS cutoff value was 75.5 for OR and 86.5 for EVAR. By 2 years postoperatively, 18 patients had died in both the EVAR and the OR patient groups. The AUC was 0.74 for OR patients and 0.78 for EVAR patients. The optimal GAS cutoff value was 74.5 for OR and 77.5 for EVAR. CONCLUSION: This is the first evaluation of the GAS in a randomized trial comparing AAA patients treated with OR and EVAR. The GAS can be used for prediction of 30-day and 2-year mortality in both OR and EVAR, but in patients that are suitable for both procedures, it is a better predictor for EVAR than for OR patients. In this study, the GAS was most valuable in identifying low-risk patients but not very useful for the identification of the small number of high-risk patients. |
| Databáze: | OpenAIRE |
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