Randall R DeMartino1, Ying Huang2, Jay Mandrekar3, Philip P Goodney4, Gustavo S Oderich2, Manju Kalra2, Thomas C Bower2, Jack L Cronenwett4, Peter Gloviczki2. 1. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: demartino.randall@mayo.edu. 2. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. 3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn. 4. Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Abstract
OBJECTIVE: The benefit of prophylactic repair of abdominal aortic aneurysms (AAAs) is based on the risk of rupture exceeding the risk of death from other comorbidities. The purpose of this study was to validate a 5-year survival prediction model for patients undergoing elective repair of asymptomatic AAA <6.5 cm to assist in optimal selection of patients. METHODS: All patients undergoing elective repair for asymptomatic AAA <6.5 cm (open or endovascular) from 2002 to 2011 were identified from a single institutional database (validation group). We assessed the ability of a prior published Vascular Study Group of New England (VSGNE) model (derivation group) to predict survival in our cohort. The model was assessed for discrimination (concordance index), calibration (calibration slope and calibration in the large), and goodness of fit (score test). RESULTS: The VSGNE derivation group consisted of 2367 patients (70% endovascular). Major factors associated with survival in the derivation group were age, coronary disease, chronic obstructive pulmonary disease, renal function, and antiplatelet and statin medication use. Our validation group consisted of 1038 patients (59% endovascular). The validation group was slightly older (74 vs 72 years; P < .01) and had a higher proportion of men (76% vs 68%; P < .01). In addition, the derivation group had higher rates of advanced cardiac disease, chronic obstructive pulmonary disease, and baseline creatinine concentration (1.2 vs 1.1 mg/dL; P < .01). Despite slight differences in preoperative patient factors, 5-year survival was similar between validation and derivation groups (75% vs 77%; P = .33). The concordance index of the validation group was identical between derivation and validation groups at 0.659 (95% confidence interval, 0.63-0.69). Our validation calibration in the large value was 1.02 (P = .62, closer to 1 indicating better calibration), calibration slope of 0.84 (95% confidence interval, 0.71-0.97), and score test of P = .57 (>.05 indicating goodness of fit). CONCLUSIONS: Across different populations of patients, assessment of age and level of cardiac, pulmonary, and renal disease can accurately predict 5-year survival in patients with AAA <6.5 cm undergoing repair. This risk prediction model is a valid method to assess mortality risk in determining potential overall survival benefit from elective AAA repair.
OBJECTIVE: The benefit of prophylactic repair of abdominal aortic aneurysms (AAAs) is based on the risk of rupture exceeding the risk of death from other comorbidities. The purpose of this study was to validate a 5-year survival prediction model for patients undergoing elective repair of asymptomatic AAA <6.5 cm to assist in optimal selection of patients. METHODS: All patients undergoing elective repair for asymptomatic AAA <6.5 cm (open or endovascular) from 2002 to 2011 were identified from a single institutional database (validation group). We assessed the ability of a prior published Vascular Study Group of New England (VSGNE) model (derivation group) to predict survival in our cohort. The model was assessed for discrimination (concordance index), calibration (calibration slope and calibration in the large), and goodness of fit (score test). RESULTS: The VSGNE derivation group consisted of 2367 patients (70% endovascular). Major factors associated with survival in the derivation group were age, coronary disease, chronic obstructive pulmonary disease, renal function, and antiplatelet and statin medication use. Our validation group consisted of 1038 patients (59% endovascular). The validation group was slightly older (74 vs 72 years; P < .01) and had a higher proportion of men (76% vs 68%; P < .01). In addition, the derivation group had higher rates of advanced cardiac disease, chronic obstructive pulmonary disease, and baseline creatinine concentration (1.2 vs 1.1 mg/dL; P < .01). Despite slight differences in preoperative patient factors, 5-year survival was similar between validation and derivation groups (75% vs 77%; P = .33). The concordance index of the validation group was identical between derivation and validation groups at 0.659 (95% confidence interval, 0.63-0.69). Our validation calibration in the large value was 1.02 (P = .62, closer to 1 indicating better calibration), calibration slope of 0.84 (95% confidence interval, 0.71-0.97), and score test of P = .57 (>.05 indicating goodness of fit). CONCLUSIONS: Across different populations of patients, assessment of age and level of cardiac, pulmonary, and renal disease can accurately predict 5-year survival in patients with AAA <6.5 cm undergoing repair. This risk prediction model is a valid method to assess mortality risk in determining potential overall survival benefit from elective AAA repair.
Authors: Elliot L Chaikof; Jan D Blankensteijn; Peter L Harris; Geoffrey H White; Christopher K Zarins; Victor M Bernhard; Jon S Matsumura; James May; Frank J Veith; Mark F Fillinger; Robert B Rutherford; K Craig Kent Journal: J Vasc Surg Date: 2002-05 Impact factor: 4.268
Authors: Manar Khashram; Julie S Jenkins; Jason Jenkins; Allan J Kruger; Nicholas S Boyne; Wallace J Foster; Philip J Walker Journal: Vascular Date: 2015-05-12 Impact factor: 1.285
Authors: Ying Huang; Peter Gloviczki; Gustavo S Oderich; Audra A Duncan; Manju Kalra; Mark D Fleming; William S Harmsen; Thomas C Bower Journal: J Vasc Surg Date: 2015-05-02 Impact factor: 4.268
Authors: Randall R De Martino; Jens Eldrup-Jorgensen; Brian W Nolan; David H Stone; Julie Adams; Daniel J Bertges; Jack L Cronenwett; Philip P Goodney Journal: J Vasc Surg Date: 2014-01-16 Impact factor: 4.268
Authors: Albeir Y Mousa; Joseph Bozzay; Mike Broce; Michael Yacoub; Patrick A Stone; Aravinda Najundappa; Mark C Bates; Ali F AbuRahma Journal: Vasc Endovascular Surg Date: 2016-04-25 Impact factor: 1.089