Independent Predictor Of Major Adverse Events Research Articles

Transthyretin amyloid cardiomyopathy in severe aortic stenosis submitted to valve replacement: a multicenter study.

Aim: To evaluate the prevalence of TTR amyloid cardiomyopathy (ATTR-CM) in severe aortic stenosis (SAS) patients, and to determine the independent predictors of major adverse events (MAE).Patients & methods: 91 SAS patients >65years with an interventricular septum thickness ≥12.5mm were referred for aortic valve replacement (AVR). 99mTc-DPD scintigraphy was applied to diagnose ATTR-CM, in the absence of monoclonal protein.Results: ATTR-CM was found in 11%. 78% of patients underwent AVR, but only 2 had ATTR-CM. There were no significant differences in the composite of all cause-mortality or cardiovascular hospitalizations. Lower left ventricle ejection fraction and not performing AVR were independent predictors of MAE.Conclusion: Not performing AVR was an independent predictor of MAE, regardless theATTR-CM diagnosis.

Prognostic implication of glomerular filtration rates in patients with chronic thromboembolic pulmonary hypertension who have undergone balloon pulmonary angioplasty.

Chronic thromboembolic pulmonary hypertension (CTEPH) plays a key role in the deterioration of lung hemodynamics and contributes to secondary dysfunction of the right heart, which is consistently accompanied by systemic malperfusion and a reduced glomerular filtration rate (GFR). The prognosis of CTEPH is markedly influenced by renal function. The aim of the present study was to evaluate the prognostic value of GFR in patients with CTEPH who have undergone balloon pulmonary angioplasty (BPA). From December 2012 to September 2020, a total of 47 patients diagnosed with CTEPH who received BPA were retrospectively studied. Patients were categorized according to their renal function on admission into two groups: GFR >53 and ≤53. Biological, clinical and demographic data of the patients were collected. Data for the two groups in hospital and during follow-up were systematically analyzed and compared. All-cause mortality, death from right heart failure (RHF) and rehospitalization associated with RHF were considered major adverse events (MAEs). The results revealed that the 6-min walk distance, N-terminal pro-B type natriuretic peptide (NT-proBNP), Troponin I and right ventricle diameter were significantly lower, and tricuspid annular plane systolic excursion was significantly higher in the GFR >53 group compared with the GFR ≤53 group at final follow-up. In addition, GFR levels were significantly correlated with NT-proBNP at baseline and final follow-up. Furthermore, based on a multivariate analysis, it was determined that the decreased GFR was an independent predictor of MAEs during follow-up. Therefore, it may be concluded that in addition to being associated with right ventricular function, decreased GFR is also a prognostic marker in CTEPH treated with BPA.

Obesity strongly predicts COVID-19-related major clinical adverse events in Coptic Clergy

Abstract Background and aims The Coptic Clergy, due to their specific work involving interaction with many people, could be subjected to increased risk of infection from COVID-19. The aim of this study, a sub-study of the COVID-19-CVD international study of the impact of the pandemic on the cardiovascular system, was to assess the prevalence of COVID-19 among Coptic priests and identify predictors of clinical adverse events. Methods Participants were geographically divided into three groups: Group-I: Europe and USA, Group II: Northern Egypt and Group III: Southern Egypt. Participants' demographic indices, cardiovascular risk factors, possible source of infection, number of liturgies, infection management and major adverse events (MAEs), comprising death, re-infection or mechanical ventilation, were assessed. Results Out of the 1,570 clergy serving in 25 dioceses, 226 (14.39%) were infected. Their mean age was 49.5±12 years and mean weekly number of liturgies was 3.44±1.0. The overall prevalence rate was 14.7% and did not differ between Egypt as a whole and overseas (p=0.23). Disease prevalence was higher in Northern Egypt clergy compared to Europe and USA combined (18.4% vs 12.1%, p=0.03) and tended to be higher than in Southern Egypt (18.4% vs. 13.6%, p=0.09). Ten priests (4.42%) died of COVID-19 related complications, 2 (0.9%) had re-infection and 27 (11.9%) suffered a MAE. The clergy from Southern Egypt were more obese but the remaining risk factors were less prevalent compared to those in Europe and USA (p=0.01). In multivariate analysis, obesity OR 4.184 (2.483 to 12.14; p=0.01); age OR 1.070 (0.014 to 1.130; p=0.02), and systemic hypertension OR 0.932 (0.874 to 0.994; p=0.007) predicted MAEs. Obesity was the most powerful independent predictor of MAE in Southern Egypt and systemic hypertension in Northern Egypt (p<0.05 for both). Conclusion Obesity is very prevalent among Coptic clergy and seems to be the most powerful independent predictor of major COVID-19-related adverse events. Funding Acknowledgement Type of funding sources: None. Prevalence of SARS-CoV2 among Clergy

Prognostic Effect of Restoring Sinus Rhythm in Patients with New-Onset Atrial Fibrillation during Acute Coronary Syndrome.

New-onset atrial fibrillation (NOAF) in acute coronary syndrome (ACS) may be associated with a poor prognosis. However, whether restoring sinus rhythm (SR) at discharge in patients with ACS improves outcomes remains unknown. A total of 552 patients with ACS at an emergency department during 2011-2016 were enrolled. According to documented electrocardiography at admission and medical records, the patients were classified into without atrial fibrillation (WAF), NOAF, and prior atrial fibrillation (PAF) groups. Major adverse events (MAEs) were defined as cardiac death, recurrent myocardial infarction, heart failure requiring hospitalization, target lesion revascularization, and stroke. The mean follow-up period of MAEs was 25 ± 15 months. Compared with the NOAF and PAF groups, the WAF group was younger and had a significantly lower heart rate, prior stroke rate, CHA2DS2-VASc score, and lower Global Registry of Acute Coronary Events (GRACE) score in the emergency department (p < 0.001). The patients in the NOAF group had the highest incidence of MAEs (p < 0.001) during follow-up, and those whose SR was restored at discharge had a lower MAE rate than those with AF at discharge (p = 0.001). In multivariable analysis, prior myocardial infarction, GRACE score, use of beta-blockers, and restoring SR at discharge were independent predictors of MAEs in the NOAF group. The patients with ACS who presented with NOAF had worse outcomes than those with PAF or WAF. The patients with NOAF whose rhythm was restored to SR at discharge were associated with better outcomes than those with AF at discharge.

The value of ECG changes in risk stratification of COVID-19 patients.

BackgroundThere is growing evidence of cardiac injury in COVID‐19. Our purpose was to assess the prognostic value of serial electrocardiograms in COVID‐19 patients.MethodsWe evaluated 269 consecutive patients admitted to our center with confirmed SARS‐CoV‐2 infection. ECGs available at admission and after 1 week from hospitalization were assessed. We evaluated the correlation between ECGs findings and major adverse events (MAE) as the composite of intra‐hospital all‐cause mortality or need for invasive mechanical ventilation. Abnormal ECGs were defined if primary ST‐T segment alterations, left ventricular hypertrophy, tachy or bradyarrhythmias and any new AV, bundle blocks or significant morphology alterations (e.g., new Q pathological waves) were present.ResultsAbnormal ECG at admission (106/216) and elevated baseline troponin values were more common in patients who developed MAE (p = .04 and p = .02, respectively). Concerning ECGs recorded after 7 days (159), abnormal findings were reported in 53.5% of patients and they were more frequent in those with MAE (p = .001). Among abnormal ECGs, ischemic alterations and left ventricular hypertrophy were significantly associated with a higher MAE rate. The multivariable analysis showed that the presence of abnormal ECG at 7 days of hospitalization was an independent predictor of MAE (HR 3.2; 95% CI 1.2–8.7; p = .02). Furthermore, patients with abnormal ECG at 7 days more often required transfer to the intensive care unit (p = .01) or renal replacement therapy (p = .04).ConclusionsPatients with COVID‐19 should receive ECG at admission but also during their hospital stay. Indeed, electrocardiographic alterations during hospitalization are associated with MAE and infection severity.

Thoracic endovascular aortic repair for symptomatic penetrating aortic ulcers and intramural hematomas is associated with poor outcomes

BackgroundThe natural history of penetrating aortic ulcers (PAUs) and intramural hematomas (IMHs) of the aorta has not been well described. Although repair is warranted for rupture, unremitting chest pain, or growth, no threshold has been established for treating those found incidentally. Thoracic endovascular aortic repair (TEVAR) offers an attractive approach for treating these pathologic entities. However, the periprocedural and postoperative outcomes have not been well defined. MethodsPatients aged ≥18 years identified in the Vascular Quality Initiative database who had undergone TEVAR for PAUs and/or IMHs from January 2011 to February 2020 were included. We identified 1042 patients, of whom 809 had follow-up data available. The patient demographics and comorbidities were analyzed to identify the risk factors for major adverse events (MAEs) and postoperative and late mortality. ResultsThe cohort was 54.8% female, and 69.9% were former smokers, with a mean age of 71.1 years. Comorbidities were prevalent, with 57.8% classified as having American Society of Anesthesiologists class 4. Of the 1042 patients, 89.8% had hypertension, 28.3% chronic obstructive pulmonary disease, 17.9% coronary artery disease, and 12.2% congestive heart failure. Patients were predominately symptomatic (74%), and 44.5% had undergone nonelective repair. The MAE incidence was 17%. The independent predictors of MAEs were a history of coronary artery disease, nonwhite race, emergent procedural indication, ruptured presentation, and deployment of two or more endografts. In-hospital mortality was 4.3%. Of the index hospitalization mortalities, 73% were treatment related. For the 809 patients with follow-up (mean, 25.1 ± 19 months), the all-cause mortality was 10.6%. The predictors of late mortality during follow-up included age >70 years, ruptured presentation, and a history of chronic obstructive pulmonary disease and end-stage renal disease. A subset analysis comparing symptomatic (74%) vs asymptomatic (26%) patients demonstrated that the former were frequently women (58.2% vs 45.3%; P < .001), with a greater incidence of MAEs (20.6% vs 6.9%; P < .001), including higher in-hospital reintervention rates (5.9% vs 1.5%; P = .002) and mortality (5.6% vs 0.7%; log-rank P = .015), and a prolonged length of stay (6.9 vs 3.7 days; P < .0001), despite similar procedural risks. During follow-up, late mortality was greater in the symptomatic cohort (12.2% vs 6.5%; log-rank P = .025), with all treatment-related mortalities limited to the symptomatic group. ConclusionsWe found significantly greater morbidity and mortality in symptomatic patients undergoing repair compared with asymptomatic patients, despite similar baseline characteristics. Asymptomatic patients treated with TEVAR had no treatment-related mortality during follow-up, with the overall prognosis largely dependent on preexisting comorbidities. These findings, in conjunction with increasing evidence highlighting the risk of disease progression and attendant morbidity associated with these aortic entities, suggest a need for natural history studies and definitive guidelines on the elective repair of IMHs and PAUs.

Psoas muscle area and attenuation are highly predictive of complications and mortality after complex endovascular aortic repair

ObjectiveThe present study evaluated the psoas muscle area and attenuation (radiodensity), quantified by computed tomography, together with clinical risk assessment, as predictors of outcomes after fenestrated and branched endovascular aortic repair (FBEVAR). MethodsThe present single-center study included 504 patients who had undergone elective FBEVAR for pararenal or thoracoabdominal aortic aneurysms. The clinical risk assessment included age, sex, comorbidities, body mass index, glomerular filtration rate, aneurysm size and extent, cardiac stress test results, ejection fraction, and American Society of Anesthesiologists (ASA) score. Preoperative computed tomography was used to measure the psoas muscle area and attenuation at the L3 level. The lean psoas muscle area (LPMA; area in cm2 multiplied by attenuation in Hounsfield units [HU]) was calculated by multiplying the area by the attenuation. The risk factors for 90-day mortality, major adverse events (MAEs), and long-term mortality were determined using multivariable analysis. MAEs included 30-day or in-hospital death, acute kidney injury, myocardial infarction, respiratory failure, paraplegia, stroke, and bowel ischemia. A novel risk stratification method was proposed according to the strongest predictors of mortality and MAEs on multivariable analysis. ResultsThe 30-day mortality, 90-day mortality, and MAE rates were 2.0%, 5.6%, and 20%, respectively. The independent predictors of 90-day mortality were chronic obstructive pulmonary disease, chronic kidney disease, ASA score, and LPMA. The independent predictors of MAEs were aneurysm diameter, glomerular filtration rate, and LPMA. For long-term mortality, the independent predictors were chronic kidney disease, congestive heart failure, extent I-III thoracoabdominal aortic aneurysms, ASA score, and LPMA. The patients were stratified into three groups according to the ASA score and LPMA: low risk, ASA score II or LPMA >350 cm2HU (n = 290); medium risk, ASA score III and LPMA ≤350 cm2HU (n = 181); and high risk, ASA score IV and LPMA ≤350 cm2HU (n = 33). The 90-day mortality and MAE rates were 1.7% and 16% in the low-, 7.2% and 24% in the medium-, and 30% and 33% in the high-risk patients, respectively (P < .001 and P = .02, respectively). Patients with ASA score IV and LPMA <200 cm2HU, indicating sarcopenia (n = 14) had a 43% risk of death within 90 days. The 3-year survival estimates were 80% ± 3% for the low-, 70% ± 4% for the medium-, and 35% ± 9% for the high-risk patients (P < .001). The mean follow-up time was 3.1 ± 2.3 years. ConclusionsLPMA was a strong predictor of outcomes and the only independent predictor of both mortality and MAEs after FBEVAR. A high muscle mass was protective against complications, regardless of the ASA score. Risk stratification based on the ASA score and LPMA can be used to identify patients at excessively high operative risk.

The selection of patients for ambulatory endovascular aneurysm repair of elective asymptomatic abdominal aortic aneurysm

ObjectivesTo identify candidates undergoing elective endovascular aneurysm repair (EVAR) of asymptomatic infrarenal abdominal aortic aneurysm who are eligible for early (≤6 hours) hospital discharge or to have EVAR performed in free-standing ambulatory surgery centers. MethodsA retrospective medical record review of all elective EVAR performed at a university medical center over 5 years was undertaken. Potential candidates for early discharge or to have EVAR performed in a free-standing ambulatory surgery setting were defined as those who used routine monitoring services only or had self-limited minor adverse events (AE) that were identified, treated, and resolved within 6 hours of surgery. Risk factors for ineligibility were determined by logistic regression. Sensitivity, specificity, negative and positive predictive values were measured to determine the veracity of the risk factor profile. ResultsThere were 272 elective EVARs; the mean patient age was 74 years (range, 52-94 years), and 75% were male. Twenty-five operative major AEs (MAE) occurred in 21 patients (7.7%): bleeding (5.9%), thrombosis (1.8%), and arterial injury (1.8%). Percutaneous EVAR (PEVAR) attempted in 260 patients (96%) was successful in 238 (88%). Failed PEVAR was associated with operative MAE (P < .001). Combined operative/postoperative MAE occurred in 43 patients (15.8%); 17 (6%) required intensive care admission; 88% directly from the operating room/postanesthesia care unit. Only two MAE (0.7%) occurred beyond 6 hours; (congestive heart failure at 24 hours, thrombosis/reoperation at 15 hours). Other AE included nausea (17%), blood pressure alteration (15%), and urinary retention (13%). Need for nonroutine services or treatment of other AE occurred in 131 (48%) patients with 79 (29%) developing or requiring treatment ≥6 hours postoperatively. However, 22 (8%) were treated/resolved in <6 hours; 30 (11%) patients required monitoring only and 36% had no complications, so, overall eligibility for same-day discharge/free-standing ambulatory surgery center was 55%. Failed PEVAR (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.25-4.49; P = .008), PEVAR performed outside of instructions for use (IFU) criteria (OR, 2.84; 95% CI, 1.07-7.56; P = .037), Endologix AFX graft (OR, 1.66; 95% CI, 1.19-2.33; P = .003) were independent predictors of MAE or AE occurring/requiring treatment >6 hours postoperatively; EVAR, which did not require an additional aortic cuff, was associated with a lower incidence (OR, 0.17; 95% CI, 0.04-0.65; P = .01). Neither aortic nor limb IFU were independent predictors. Profiles using PEVAR IFU, PEVAR failure, and graft type demonstrated only moderate sensitivity (63%), specificity (71%), positive predictive value (70%), and negative predictive value (63%). ConclusionsMore than one-half of all patients who undergo EVAR are ready for discharge within 6 hours postoperatively. Failed PEVAR, aortic cuffs, and Endologix AFX graft were independent predictors of MAE or AE occurring/requiring treatment for ≥6 hours. However, sensitivity parameters of this profile were insufficient to advocate EVAR in free-standing ambulatory surgical units at this time, but hospital-based ambulatory admission with same-day discharge would be a viable option because of easy inpatient transition for those requiring continued care.

Sex-based impact of carotid plaque in patients with chest pain undergoing stress echocardiography

ObjectiveWomen with suspected angina without history of coronary artery disease (CAD) less frequently have flow-limiting stenosis (FL-CAD) and more often have microvascular disease, affecting predictive accuracy of stress echocardiography (SE)...

Effect of Concomitant Coronary Artery Bypass Grafting on Outcomes of Ascending Aorta Replacement

Ascending aorta replacement can be performed safely in high-volume centers. What remains unknown is whether concomitant coronary revascularization with bypass grafting affects postoperative outcomes. This study retrospectively reviewed a prospectively maintained institutional database for patients who underwent ascending aorta replacement (AAR) during the period from 1997 to 2018. Patients were stratified into AAR alone (AAR) vs AAR and coronary artery bypass graft (AAR with CABG), further categorized as 1 or more than 1 CABG. Aortic dissection and root replacement cases were excluded. The primary end point consisted of major adverse events (MAE), including operative mortality, perioperative myocardial infarction, stroke, need for tracheostomy, and need for dialysis. Secondary end points were operative mortality, each MAE component, and late survival. A total of 951 patients were included in the analysis; 725 (76.2%) underwent isolated AAR, and 226 (23.8%) underwent AAR with CABG. Operative mortality was similar across the 2 groups (1.8% for AAR with CABG and 0.8% for AAR; P= .40). The unadjusted incidence of MAE was higher in the AAR with CABG group (5.8% vs 1.9%; P= .005).). On multivariable analysis, the performance of 1 CABG (odds ratio [OR], 1.90; 95% confidence interval [CI], 0.67 to 5.33; P= .23) and more than 1 CABG (OR, 2.65; 95% CI, 0.93 to 7.53; P= .07) was not associated with higher rates of MAE. Preoperative pulmonary dysfunction (OR, 2.51; 95% CI, 1.07 to 5.85; P= .03) was the only independent predictor of MAE. In patients undergoing concomitant CABG with AAR, the performance of concomitant CABG is not associated with an increased risk of MAE.

Learning curve of fenestrated and branched endovascular aortic repair for pararenal and thoracoabdominal aneurysms

ObjectiveThe objective of this study was to review the learning curve for fenestrated-branched endovascular aortic repair (F-BEVAR) of pararenal and thoracoabdominal aortic aneurysms (TAAAs). MethodsWe reviewed the clinical data of 334 consecutive patients (255 males, mean age 75 ± 7 years) who underwent F-BEVAR between 2007 and 2016 in a single institution. Outcomes were analyzed in four quartiles of experience (Q1-Q4). Study outcomes included trends in patient characteristics, device design, procedural variables, 30-day mortality, and major adverse events (MAEs). ResultsThere were 178 patients (53%) treated for pararenal aneurysms and 156 (47%) for TAAAs. During the study period, there was a statistically significant increase in the proportion of TAAAs and in the number of vessels incorporated. Despite this, there was a steady decrease in 30-day mortality (6% in Q1 to 0% in Q4; P < .04) and in the rate of MAEs (60% in Q1 to 29% in Q4; P<.001). By linear regression analysis, there was significant decline in estimated blood loss (1358 ± 1517 mL in Q1 to 486 ± 520 mL in Q4; P < .001), total operating time (325 ± 116 minutes in Q1 to 248 ± 92 minutes in Q4; P < .001), total fluoroscopy time (121 ± 59 minutes in Q1 to 85 ± 39 minutes in Q4; P < .001), contrast volume (201 ± 92 mL in Q1 to 160 ± 61 mL in Q4; P = .002), and radiation dose (4141 ± 2570 mGy in Q2 to 2543 ± 1895 mGy in Q4; P < .001). Independent predictors of MAEs were total operating time (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.8; P < .001), Society for Vascular Surgery total score (OR, 1.1; 95% CI, 1.02-1.2; P = .009), and quartile 1 (OR, 3.0; 95% CI, 1.7-5.2; P < .001). ConclusionsThis study demonstrates significant improvement in perioperative mortality, MAEs, procedural variables, and secondary interventions in patients treated by F-BEVAR, despite the increase in complexity of aneurysm pathology during the study period. Also, better patient selection contributed to improve outcomes.

Relationship between normal preoperative white blood cell count and major adverse events after endovascular repair for abdominal aortic aneurysm: results of a pilot study

Study objectiveTo examine the association between preoperative white blood cell (WBC) count within the reference range and major adverse events (MAEs) following endovascular repair of abdominal aortic aneurysms (AAA). DesignProspective observational study. SettingVascular surgery clinic in a tertiary university hospital. PatientsOne hundred fifty-three consecutive patients. InterventionEndovascular repair of AAA. MeasurementsAll patients had normal preoperative WBC count (3.5-10.3 K/μL). Postoperative MAE was defined as death, stroke, and myocardial infarction. The prognostic value of preoperative WBC was determined by receiver operating characteristic curves, whereas χ2 test and Cochran-Armitage trend test were used to assess the association between MAE and different values of WBC. Main resultsA preoperative WBC cutoff value of 7.3 Κ/μL could predict MAE with 62% sensitivity and 62% specificity (area under the curve, 0.62). Patients with higher preoperative WBC experienced more events compared with patients with lower values (P=.027). A linear relationship was observed between an increasing preoperative WBC count within the reference range and the risk of postoperative events (P=.004). Logistic regression analysis showed that preoperative normal WBC count was an independent predictor of MAE and revealed that for every 1-K/μL increase, patients had a 32.8% increase in their relative odds of developing postoperative MAE (P=.035). ConclusionsThis pilot study demonstrates a linear correlation between an increasing preoperative WBC count within the reference range and an increased risk for postoperative MAEs following endovascular repair for AAA. Identification of high-risk patients at an early stage by using WBC count could prove useful in implementing measures to improve their clinical outcome.

The prognostic value of left ventricular global peak systolic longitudinal strain in chronic peritoneal dialysis patients

BackgroundAlthough left ventricular (LV) global systolic longitudinal strain (GLS) reliably and accurately assesses LV systolic function and is also a powerful prognostic predictor, the importance and prognostic value of GLS in end-stage renal disease patients receiving maintenance peritoneal dialysis (PD) remain unclear. This study sought to determine the prognostic value of GLS in chronic PD patients. MethodsThis prospective study collected clinical and echocardiographic data from 106 stable PD patients (50.0±13.9years, 45% male) in a dialysis unit of a university hospital. These patients were enrolled from April 2010 to June 2010 and followed until August 2013 (follow-up duration 30.3±14.3months). The primary outcomes were the presence of major adverse events (MAEs), defined as all-cause mortality, and major adverse cardiovascular cerebral events (MACCEs), i.e. cardiovascular death, cardiac hospitalization, and stroke. ResultsTwenty-nine patients (27%) reported a primary outcome. Patients with MAEs had worse LV systolic function (MAEs vs. no MAEs, −14.8±2.8 vs. −17.1±2.5%, p=0.003). Using multivariate Cox regression analyses, being male, having a history of heart failure, diabetes mellitus, an increased pulse pressure (≥60mmHg), and GLS≥−15% were independent predictors of MAEs. The independent risk factors of MACCEs were a history of diabetes mellitus, an increased pulse pressure, and GLS≥−15%. After comparison of the overall log likelihood χ2 of the predictive power, GLS was found to add prognostic information to a model based on traditional risk factors. ConclusionGLS≥−15% provided additional prognostic information that allowed for the early identification of high-risk PD patients.

Differential effect of nutritional status on vascular surgery outcomes in a Veterans Affairs versus private hospital setting

BackgroundThe goal of this study was to determine whether preoperative albumin level in vascular surgery patients is predictive of postoperative outcomes in the Veterans Affairs (VA) versus private sector and in open versus endovascular interventions. MethodsA retrospective analysis of male patients with peripheral arterial disease, carotid artery disease, and abdominal aortic aneurysms who underwent open or endovascular interventions at the Jesse Brown VA Medical Center or Northwestern Memorial Hospital from January 2006 to June 2009 was conducted. Preoperative demographics and postoperative outcomes were assessed. Major adverse events (MAE) were defined as myocardial infarction, stroke, or death. ResultsA total of 591 men were included. Preoperative albumin level was significantly higher in VA versus private sector patients (3.6 ± .5 g/dL vs 3.2 ± .8 g/dL, respectively; P = .0001) and endovascular versus open patients (3.6 ± .6 g/dL vs 3.3 ± .7 g/dL, respectively; P < .0001). Albumin level was an independent predictor of MAE (odds ratio [OR], .46; P = .04) and 1-year death (OR, .35; P = .01) for all patients, and was predictive of MAE (OR, .40; P = .05) and 1-year death (OR, .23; P = .0008) in the open cohort. ConclusionsPreoperative malnutrition has important prognostic implications for vascular surgery patients in both the VA and private hospital settings, especially for those patients undergoing open repair.