Abstract 9893: Preoperative Lower Cholesterol Level is the Independent Risk Factor of Severe Postoperative Mortality in Patients With Ruptured Abdominal Aortic Aneurysm
Background: Hypocholesterolemia is reported to be the critical risks of hemorrhagic stroke, but the influence of hypocholesterolemia on large vessels such as abdominal aortic aneurysm (AAA) is unknown.
Methods: We conducted a retrospective cohort study on 1053 consecutive patients receiving the surgical repair for infrarenal AAA in multicenter in Tokyo from 2003 through 2011. Laboratory data including total cholesterol levels were measured immediately before surgery. Cox hazards model were used to evaluate the risk factors for the postoperative mortality as well as major adverse cardiac events (MACE; composite of cardiovascular death without postoperative in-hospital death, acute coronary syndrome, cerebrovascular disorder).
Results: The average follow-up period was 2.5 ± 2.1 years. In the multiple Cox analysis adjusted for age, gender, aneurysm size, smoking, hypertension, diabetes, past history of coronary disease, past history of chronic obstructive pulmonary disease, anemia, shock, statin use, β-blocker use and angiotensin II receptor blocker use, anemia (hemoglobin level < 10 g/dl), shock and hypocholesterolemia (total cholesterol level < 120 mg/dl) before surgery were found to be the risk factors of all postoperative death in patients with ruptured AAA (HR3.3; 95%CI 2.0-5.3, HR2.5; 95%CI 2.0-4.7, HR;5.4 CI 3.0-9.7, respectively, n=183). Meanwhile, there found to be no risk factor of all death in non-ruptured AAA (n=870). Furthermore, the mortality of patients with each total cholesterol level 120 - 140, 140 - 160, and 160 - 180 mg/dl was higher than that of total cholesterol level > 180 mg/dl (HR3.2; 95%CI 1.9-5.2, HR2.7; 95%CI 1.6-4.4, HR1.8; 95%CI 1.0-3.2, respectively). Receiver operator characteristic (ROC) curve analysis showed hypocholesterolemia is the most significant predictor of postoperative in-hospital death in patients with ruptured AAA (the area under the ROC curve = 0.77). The risk factor of MACE was identified to be the existence of preoperative coronary artery disease.
Conclusions: The risk factors of poor mortality in patients with ruptured AAA were anemia, shock and hypocholesterolemia. The lower total cholesterol level indicated the more severe mortality of ruptured AAA.
- © 2012 by American Heart Association, Inc.