Abstract 14618: Comparative Outcomes of Elective Endovascular Abdominal Aortic Aneurysm Repair in Patients With Preoperative Cardiac Stress Testing

Abstract

Introduction: The use of cardiac stress testing (CST) before endovascular abdominal aortic aneurysm (EVAR) repair is controversial. While prior research has explored the utility of CST before EVAR, EVAR outcomes in patients with different CST results have not been studied. The objective of this study is to evaluate EVAR outcomes in patients with abnormal CST. Hypothesis: Patients with abnormal CST before EVAR have inferior outcomes compared to patients with normal CST. Methods: The Vascular Quality Initiative (VQI) database for EVAR was reviewed. Patients who underwent CST prior to elective EVAR were included. In VQI, abnormal CST is defined as having ischemia, infarction, or both ischemia and infarction (BII). Outcomes of patients with normal and abnormal CST were compared, including a subgroup analysis of CST abnormalities. Results: A total of 19,964 patients were included and 23.7% (4,723) had abnormal CST. Patients with abnormal CST were more commonly males with comorbidities. Patients with abnormal CST had significantly more perioperative complications including MACE and one-year mortality compared to patients with normal CST. ( Table ) Regression analysis revealed that abnormal CST was independently associated with increased perioperative MACE (OR=1.59 [1.28-1.97]) and one-year mortality (HR=1.11 [1.00-1.23]). Subgroup analysis of patients with abnormal CST showed that patients with BII had significantly more perioperative MACE (6.8% vs 4.1%, P =0.002) and mortality (1.1% vs 0.4%, P =0.040) compared to patients with either ischemia or infarction. BII was independently associated with MACE (OR=1.62 [1.06-2.41]) and 30-day mortality (OR=3.28 [1.21-8.16]) compared to either abnormality. Conclusions: Patients with abnormal CST have worse outcomes after elective EVAR compared to patients with normal CST, particularly patients with BII. CST is a useful tool for perioperative and long-term risk stratification in patients undergoing elective EVAR.