The Use of Cardiovascular Biomarkers in Abdominal Aortic Surgery: Possibility of Risk Assessment and Stratification

Background:

The prevalence of coronary artery disease (CAD) in patients with aneurysmal or occlusive disease of the aorta is high: more than 50 percent of patients suffering from peripheral arterial occlusive disease (PAOD) or abdominal aortic aneurysm (AAA) do also have coronary artery disease. As a result, cardiovascular disease is the leading cause of morbidity and mortality in patients undergoing aortic surgery.

Identifying patients at increased risk of cardiac complications following major vascular surgery is also part of the decision-finding process when patients are assigned to open or endovascular surgery. The 30-day mortality rate for elective open aneurysm repair (OR) is estimated to be 4 to 8%, while endovascular aneurysm repair (EVAR) has a perioperative risk of 1.2 to 1.6%. However, the early survival advantage of patients undergoing EVAR disappears with time and all-cause mortality is similar for EVAR and open repair at late follow-up. Patients treated by EVAR show a higher number of complications and reinterventions, and a significant proportion of late deaths after EVAR are due to aneurysm rupture.

Therefore, patients who need abdominal aortic surgery are required to undergo a thorough medical examination, on the one hand to assess cardiac capacity, on the other hand to estimate life expectancy. Current recommendations for the preoperative management of patients undergoing major non-cardiac vascular surgery include physical examination and routine performance of electrocardiogram and echocardiogram as part of a cardiovascular evaluation. However, guidelines do not include routine screening with cardiac enzymes or cardiac stress markers.

Biomarkers: