Abstract 219: Cardiac Stress Testing Does Not Improve Patient Selection or Outcomes Among Patients Undergoing Abdominal Aortic Aneurysm Repair

Abstract

Objectives: Cardiac stress testing (CST) is commonly used to help determine whether patients with abdominal aortic aneurysms (AAA) are candidates for an open vs. endovascular repair, although it is unknown whether use of CST achieves its goal of optimizing patient selection and postoperative outcomes. This study was designed to examine whether utilization of CST reduces adverse cardiac events and improves survival following AAA repair. Methods: We retrospectively identified 3,635 patients in the Vascular Quality Initiative (VQI) database (2010- 2012) with an AAA ≥ 5.0cm who were candidates for open or endovascular AAA repair. The Vascular Study Group Cardiac Risk Index (VSG-CRI) was used to stratify patient risk. We applied generalized estimating equations with inverse probability weighting to adjust for patient factors and hospital level CST utilization to evaluate the effect of CST on composite of 30-day major adverse cardiac events or mortality (MACE-M) following AAA repair. Analyses were restricted to hospitals with 20% to 80% CST utilization to facilitate adjustment of the utilization rate. Results: CST was utilized in 1627 (45%) patients during AAA workup, including 451 of 794 (57%) patients selected for open repair and 1176 of 2841 (41%) selected for endovascular repair. After inverse probability weighting, the use of CST was not associated with the probability of patients receiving open vs. endovascular repair (OR: 1.00; 95%CI: 0.77-1.32). As compared to patients without CST during AAA workup, adjusted analyses revealed that CST utilization was not associated with improved MACE or mortality outcomes following AAA repair. Among patients receiving CST, an abnormal CST was not significantly associated with selection of open vs. endovascular repair or with postoperative outcomes after adjustment for the VSG-CRI score. Similar results were found for patients with either low or high VSG-CRI scores. Conclusions: Utilization of CST during workup for AAA is not associated with selection of repair procedure and improved postoperative outcomes. Our results suggest that CST adds no value beyond known clinical risk factors in selecting patients for open or endovascular repair or in predicting post-operative events.