SynthesisAnnals of medicine2025
A validated predictive model for mid- and long-term mortality risk assessment after elective endovascular repair in abdominal aortic aneurysm patients.
Synthesis in Annals of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRisk scoring systems for open surgical repair of abdominal aortic aneurysm (AAA) may overestimate mortality after endovascular aneurysm repair (EVAR). A model for mid-term and long-term mortality after EVAR is still lacking. MATERIAL AND
methodMEDLINE, Embase and WOS were searched from January 1, 2000 to December 31, 2022. Hazard ratios and 95% confidence intervals (CI) for mortality-related risk factors were extracted and synthesized in a meta-analysis. The C-statistics, IDI, NRI and DCA were used to assess the stability. A predictive model incorporating independent meta-analytic variables was developed, validated in a clinical cohort and compared with the Giles model.
results35 studies containing 49272 patients were analyzed. A prediction model was established, including age, gender, aneurysm diameter, American Society of Anesthetists score, chronic obstructive pulmonary disease, cardiac disease, renal disease, cerebrovascular disease, diabetes, peripheral vascular disease, statins, aspirin, and smoker. The model had a C-statistic of 0.738 (95%CI:0.697, 0.779) in validation cohort, comprising 537 patients after EVAR. The sensitivities were 0.765, 0.796 and 0.756, and the specificities were 0.744, 0.652 and 0.668 at 1/3/5 years. In contrast, Giles model had a C-statistic of 0.657 (95%CI:0.608, 0.706). Integrated discrimination improvement (0.03,
conclusionThis meta-analysis-derived AAA long-term mortality prediction model employs precision risk stratification to enhance clinical decision-making and implement personalized follow-up protocols, thereby delivering evidence-based support for clinical practice.
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