Post-implantation syndrome (PIS) is the clinical and biochemical expression of an inflammatory response following endovascular aneurysm repair, with a reported incidence ranging from 2-100%. Although generally benign, some studies report an association between PIS and post-operative major adverse cardiovascular events (MACE). Nonetheless, the role of PIS in post-operative myocardial injury (MINS) is unknown. This work aims to evaluate the relation between post-implantation syndrome and MINS in a subset of EVAR patients, as well as assess the impact of PIS in all-cause mortality.
All patients undergoing elective standard EVAR between January 2008 and June 2017, and with at least one measurement of contemporary (cTnI) or high sensitivity troponin I (hSTnI) in the first 48h after surgery, were retrospectively analyzed. Post-implantation syndrome was defined as the presence of fever and leukocytosis in the postoperative period in the absence of infectious complications. MINS was defined as the value exceeding the 99th percentile of a normal reference population with a coefficient of variation <10%, which was >0.032ng/ml for cTnI and 0.0114 (female) and 0,027ng/ ml (male) for hSTnI. Patients demographics, comorbidities, medication, access and anesthesia were also evaluated.
One hundred and thirty-three consecutive patients were included (95.5% male; mean age 75.66 years±7,13). Mean follow-up was 46.35 months. Survival rate was 86.5%, 80.5% and 57.6% at 1, 3 and 5 years of follow-up, with two fatalities at 30 days follow-up. The prevalence of post-implantation syndrome was 11.4%. MACE occurred in 2.3% of the patients, while MINS was reported in 16.5% of the patients. No association was found between PIS and patients’ gender, comorbidities, type of anesthesia or transfusional support. The type of graft used significantly affected the prevalence of PIS, with all cases reported when polyester grafts were used (p=0.031). MACE occurred in 2.3% of the patients, while MINS was reported in 16.5% of the patients. PIS was found to be significantly associated with post-operative MACE (p=0.001), but not MINS. Survival analysis revealed no differences between patients with or without PIS regarding 30-day mortality as well as long-term all-cause mortality. ASA score (HR 2.157; 95% CI 1.07 – 4.33, P=0.031) and heart failure (HR 2.284; 95% CI 1.25 – 4.18, P=0.008) were found to be independently associated with increased long-term all-cause mortality in this cohort of patients.
PIS is a common complication after EVAR, occurring in 11.4% of the patients from this cohort. Graft type seems to significantly affect the risk of PIS, since all reported cases occurred when polyester grafts were used. PIS did not influence 30-day or long-term survival and was found to be significantly associated with post-operative MACE but not MINS, suggesting the involvement of different pathophysiological mechanisms.
Copyright © 2020. Published by Elsevier Inc.