ASSOCIATION OF POLYPHARMACY SCORES WITH THE LONG-TERM SURVIVAL OF PATIENTS WITH INTACT AORTO-ILIAC ANEURYSMS AND INDICATION FOR REPAIR.

Autores de IIS La Fe

• Manuel Miralles Hernández

  Autor

Participantes ajenos a IIS La Fe

• Pumares-Garcia, Lorena
• Paredes-Marinas, Ezequiel
• Calsina-Juscafresa, Laura
• Subirana-Cachinero, Isaac
• Clara-Velasco, Albert

Grupos

• Hemostasia, Trombosis, Arteriosclerosis y Biología vascular

  

  Investigador Principal

  Pilar Medina Badenes

Abstract

BACKGROUND: Our study analysed the relationship between two polypharmacy scores (Addition of Chronic Prescribed Drugs -ACPD- and Rx-Risk comorbidity index) and survival in patients with an intact abdominal aortic and/or common iliac aneurysm (AAA). MATERIALS: Consecutive retrospective single-center cohort of patients attended for an intact AAA with indication for repair from 2008 to 2021. METHODS: Demographic data, Charlson comorbidity index, AAA treatment, ACPD and Rx-Risk polypharmacy scores were recorded at baseline. Main outcomes were the 5-year and long-term survival rates. The statistical analysis included Cox regression, area under the curve, and continuous net reclassification index. RESULTS: Four-hundred twenty-four patients with AAA were evaluated (median age 76 years old; 92.2% male, median Charlson index 2), of whom 314 (74.1%) underwent intervention (80% endovascular and 20% open) and 110 (25.9%) not. During follow-up (mean 4.6 years), 245 patients (57.8%) died, with 1-month, 1-, and 5-year survival rates of 98.1%, 86.3%, and 52.7%, respectively. ACPD and Rx-Risk indices (median 6 interquartile range [4-9] and 3 [0-5], respectively) were significantly and linearly associated (p<0.001) with survival, with the best cut-off points at 5 and 0, respectively. An ACPD>5 (patients with >5 chronically prescribed drugs at baseline) and an Rx-Risk>0 were associated with a 45.2% (p=0.038) and 102% (p=0.002) increase in 5-year mortality, after adjustment for age, gender, Charlson index, and type of AAA treatment. Both polypharmacy indices improved significantly the discriminative power of the Charlson comorbidity index in predicting survival. CONCLUSIONS: Both ACPD and Rx-Risk polypharmacy scores are independently related to survival among patients with an intact AAA and indication for repair. Their behaviour is similar, so the simple ACPD>5 appears to be sufficient to identify patients with lower survival rates.

Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Keywords

• Abdominal aortic aneurysm; Comorbidity; Polypharmacy; Rx-Risk index; Surgery; Survival