• Emmanuelle Duceppe, Dorota Studzińska, P J Devereaux, Kamil Polok, Anna Gajdosz, Krzysztof Lewandowski, Maciej Zaniewski, Marcin Zaczek, Bogusław Rudel, and Wojciech Szczeklik.
• Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada.
• Can J Anaesth. 2019 Nov 1; 66 (11): 1338-1346.

PurposeWe performed a retrospective cohort study in patients who underwent endovascular aneurysm repair (EVAR) to determine the incidence and predictors of myocardial injury and acute kidney injury (AKI).MethodsWe included 267 consecutive patients who underwent EVAR at two tertiary centres in Canada and Poland. The primary outcome was myocardial injury during hospital stay after EVAR defined as a troponin elevation (ultra-sensitivity troponin I Vidas ≥ 19 ng·L-1, non-high-sensitivity troponin I Vidas ≥ 0.01 µg·L-1, high-sensitivity troponin T ≥ 20 ng·L-1, non-high-sensitivity troponin T ≥ 0.03 ng·mL-1). The secondary outcome was AKI defined using the stage 1 of the Acute Kidney Injury Network criteria.ResultsMyocardial injury occurred in 78/267 patients (29%; 95% confidence interval [CI], 24.1 to 34.9) and with AKI occurring in 25/267 (9.4%; 95% CI, 6.4 to 13.5). In a multivariable analysis, the following variables were associated with an increased risk of myocardial injury: age (adjusted odds ratio [aOR], 1.65 per ten-year increase; 95% CI, 1.09 to 2.49), Revised Cardiac Risk Index score ≥3 (aOR, 2.85; 95% CI, 1.26 to 6.41), The American Society of Anesthesiology physical status score 4 (aOR, 2.24; 95% CI, 1.12 to 4.47), duration of surgery (aOR, 1.27 per each hour; 95% CI, 1.00 to 1.61), and perioperative drop in hemoglobin (aOR, 3.35 per 10 g·dL-1 decrease; 95% CI, 1.00 to 11.3). Predictors of AKI were duration of surgery (aOR, 1.72 per hour; 95% CI, 1.36 to 2.17), a preoperative estimated glomerular filtration rate (eGFR) of 30-59 mL·min-1 (aOR, 3.82; 95% CI, 1.42 to 10.3), and an eGFR < 30 mL·min-1 (aOR, 37.0; 95% CI, 7.1 to 193.8).ConclusionMyocardial injury and AKI are frequent during hospital stay after EVAR and warrant further investigation in prospective studies.

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