Incidence Of Myocardial Injury In Patients Submitted To Abdominal Aortic Aneurysm Repair: a systematic review and metanalysis

Abstract

Background and Aims: The correction of abdominal aortic aneurysms (AAA) is a major vascular surgery that carries risk of myocardial injury following non-cardiac surgery (MINS). Recent evidence suggests MINS occurs in approximately 20% of patients undergoing noncardiac surgery and affects patient outcomes, but its incidence is not determined in this subset of patients. This systematic review aims to determine the incidence of MINS in patients undergoing AAA repair. Methods: MEDLINE, WOS, and Scopus were systematically searched for studies assessing MINS in the postoperative setting of AAA correction. The incidence of MINS in EVAR and OAR was pooled by random-effects meta-analysis, with sources of heterogeneity being explored by meta-regression and leave-one-out sensitivity analysis. Assessment of studies' quality was performed using NHLBI Study Quality Assessment Tool and RoB 2 Tool. Results: Eighteen studies were included, with a total of 26,302 participants. Two of them were RCTs, while the remaining were cohort studies. In the studies age ranged from 65.8 to 75.5 and 86.8% of all patients were male. The pooled incidence of MINS after AAA repair ranged from 0.4% to 20.7% for EVAR and 1.8% to 46.8% for OAR. Meta-analytical incidence of MINS after EVAR was 13.1% [95%CI 5.6-20.7%] in cohort studies and 0.9% [95%CI 0.4-1.4%] in multicentre database studies, both with severe heterogeneity (I²= 97.2% and 79.1%). For OAR, the incidence was 30.6% [95%CI 19.5-41.7%] in cohort studies, 3.2% [95%CI 1.8-4.6%] in multicentre database studies, and 32.4% [95%CI 18.1-46.8%] in RCTs, all with high heterogeneity (I²= 96.8%, 86.6%, and 71.3%). Conclusion: The incidence of MINS was significant, and results indicate a possible difference in incidence in patients that underwent EVAR and OAR, but the significant heterogeneity found indicates a need for additional research with consistent methodology and definitions to assess the true incidence of MINS.