Short journal club presentation

2. Glasgow Aneurysm Score predicts survival
after endovascular stenting of abdominal
aortic aneurysm in patients from the
EUROSTAR registry
F. Biancari 1, R. Hobo 2 3 *, T. Juvonen 1, on behalf of the EUROSTAR collaborators
1Division of Cardiothoracic and Vascular Surgery, Oulu University Hospital, Oulu, Finland
2EUROSTAR Data Registry Centre, Catharina Hospital, Eindhoven, The Netherlands
3EUROSTAR Secretary, Department of Vascular Surgery, Royal University Hospital, Liverpool, UK
British Journal of Surgery, 2006

3. Glasgow Aneurysm Score predicts survival after
endovascular stenting of abdominal aortic
aneurysm in patients from the EUROSTAR registry
• Glasgow Aneurysm Score (GAS) is a tool to predict postoperative mortality
after aneurysma repair
• Risk score = [age in years] + [7 points for myocardial disease] + [10 points
for cerebrovascular disease] + [14 points for renal disease]
• myocardial disease = previously documented myocardial infarction and/or
ongoing angina pectoris
• cerebrovascular disease = all grades of stroke including transient ischaemic
attack (TIA)
• renal disease = history of acute or chronic renal failure and/or creatinine
level above 133 µmol/l and/or creatinine clearance below 50ml/min

4. Glasgow Aneurysm Score predicts survival after
endovascular stenting of abdominal aortic
aneurysm in patients from the EUROSTAR registry
Endovascular

5. Glasgow Aneurysm Score predicts survival after
endovascular stenting of abdominal aortic
aneurysm in patients from the EUROSTAR registry
• EUROpean collaborators on Stent-
graft Techniques of abdominal aortic
Aneurysm Repair = EUROSTAR
• Study period: 5498 patients who
undervent endovascular repair
(EVAR) enrolled between October
1996 - March 2005

6. 5498 patients from 160 centers prospectively
included with:
• non-ruptured, asymptomatic infrarenal, abdominal,
aortic aneurysms (AAA)
• diameter 40mm or greater
• written consent
excluded:
• withdrawn endograft

7. pectoris. Cerebrovascular disease refers to all grades of 59·5 per cent of patients, 5·7 per cent had
stroke and includes transient ischaemic attack. Renal disease and 18·2 per cent had renal disea
disease refers to a history of acute or chronic renal GAS was 78·8 (i.q.r. 71·9–86·4, mean 79·
5498 patients from 160 centers
failure and/or a creatinine level above 133 µmol/l and/or
creatinine clearance below 50 ml/min, that is a Society for
Thirty-day postoperative mortality
One hundred and fifty-five patients (2
Table 1 Types of stent-graft used for endovascular aneurysm within 30 days of the initial procedure. U
repair showed that preoperative aneurysm diam
and GAS (P < 0·001) were associated w
Zenith (William Cook) 1916 (34·8)
Talent (Medtronic/AVE) 1557 (28·3)
risk of death within 30 days. Tertile 3
AneuRx (Medtronic/AVE) 907 (16·5) rates were 1·1 per cent for patients with
Excluder (W. L. Gore) 737 (13·4) 74·4, 2·1 per cent for those with a sco
Lifepath (Edwards Lifesciences) 119 (2·2)
and 83·6, and 5·3 per cent for patients w
Powerlink (Endologix) 92 (1·7)
Fortron (Cordis/Johnson & Johnson) 77 (1·4) 83·6 (P < 0·001). Multivariate analysis sh
EVT (Guidant) 69 (1·3) independently predicted postoperative de
Anaconda (Sulzer Vascutek) 24 (0·4) Analysis of the ROC curve showed
had an area under the curve of 0·70 (9
William Cook, Bloomington Indiana, USA; Medtronic/AVE, Santa Rosa,
dence interval (c.i.) 0·66 to 0·74; s.e. 0·02
California, USA; W. L. Gore, Flagstaff, Arizona, USA; Edwards
Lifesciences, Irvine, California USA; Endologix, Irvine, California, USA;
predicting postoperative death. Accordin
Cordis/Johnson & Johnson, Fort Lauderdale, Florida, USA; Guidant, the best cut-off value was 86·6, which
Menlo Park, California, USA; Sulzer Vascutek, Inchinnan, UK. tivity of 56·1 per cent, specificity 76·2 p
• Follow-Up scheduled 1,3,6,12,18 and 24 months after surgery, then British Journal of Surgery
www.bjs.co.uk
annually.
Copyright © 2006 British Journal of Surgery Society Ltd
Published by John Wiley & Sons Ltd
• All the patients had a minimum follow-up of 1 month unless death,
aneurysm rupture or conversion to open repair occurred before the first
outcome visit.

8. RESULTS!
5498 patients (94,1% men)
median age 72,7 years (i.q.r. 67,3-77,7)
median aortic diameter 56mm (i.q.r. 51-63)
myocardial disease 59,5%
cerebrovascular disease 5,7% median GAS
renal disease 18,2% 78,8 points
(i.q.r. 71,9-86,4)
Thirty-day postoperative mortality:
2 factors: aneurysm diameter / GAS
155 (2,4%) patients died
GAS < 74,4: 1,1% tertile mortality Multivariate analysis
74,4 < GAS < 83,6: 2,1 % tertile mortality showed: GAS predicted
GAS > 83,6: 5,3% tertile mortality independently
postoperative death

9. RESULTS!
Long-term outcome:
median follow up was 18 months
(i.q.r. 6-24)
Overall survival rates were:
91,7% after 1 year
87,1% after 2 years
76,7% after 5 years
differed significantly (P < 0.0001) among
tertiles
Overall rupture rates were:
0,2% after 1 year
0,6% after 2 years
1,7% after 5 years
differed not significantly (P < 0.225)
between tertiles