ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2025 Jan 09

DOI: 10.23736/S0021-9509.24.13135-7

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

Chronic kidney disease as a predictor of long-term adverse cardiovascular outcomes in patients with aortoiliac disease: a prospective cohort study

Mariana ALVES ¹, Ana-Daniela PIAS ¹, Joana MARQUES ¹, Conceição MIRANDA ¹, António PEREIRA-NEVES ^{2, 3, 4}, Mohammed SHAHAT ⁵, José VIDOEDO ⁶, José P. ANDRADE ^{4, 7}, João ROCHA-NEVES ^{4, 7} ✉, Ana MARREIROS ^{1, 8}

¹ Faculty of Medicine and Biomedical Sciences, Campus of Gambelas, University of Algarve, Faro, Portugal; ² Department of Angiology and Vascular Surgery, Local Health Unit of São João, Porto, Portugal; ³ Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; ⁴ Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; ⁵ Department of Vascular and Endovascular Surgery, University Hospitals of Assiut, Assiut, Egypt; ⁶ Department of Angiology and Vascular Surgery, Local Health Unit of Tâmega e o Sousa, Penafiel, Portugal; ⁷ CINTESIS@RISE, Porto, Portugal; ⁸ ABC-RI, Algarve Biomedical Center Research Institute, Faro, Portugal

BACKGROUND: Aortoiliac disease poses a significant cardiovascular (CV) risk, especially in individuals with chronic kidney disease. This study aimed to assess the predictive role of chronic kidney disease in long-term major adverse CV events in patients submitted to aortoiliac revascularization due to severe aortoiliac atherosclerotic disease.
METHODS: From 2013 to 2023, patients who underwent aortoiliac revascularization for TASC II type D lesions, including those with chronic kidney disease, were selected from a prospective cohort study. Demographic, clinical, and postoperative data were collected. Prognostic factors were evaluated for their independent impact on outcomes using survival analysis with a multivariate Cox regression model.
RESULTS: The study included 135 patients, 93.3% male, with a mean age of 62.39±9.20 years. Chronic kidney disease was associated with higher prevalence of short-term myocardial injury after noncardiac surgery (54.5%, P=0.014) and was a long-term predictor of acute heart failure (Hazard Ratio=4.884; 95% confidence interval 2.377-22.802; P=0.007), major adverse CV events (HR 2.992; 95% CI 1.498-5.975, P=0.002) and all-cause mortality (HR 3.296; 95% CI 1.626-6.682, P<0.001). The multivariable analysis revealed significant associations between major adverse CV events and the following predictors: chronic kidney disease (adjusted HR=2.416, 95% CI 1.171-4.984, P=0.017) and congestive heart failure (adjusted HR=2.633, 95% CI 1.233-5.623, P=0.012).
CONCLUSIONS: Chronic kidney disease is a recognized CV risk factor and an independent predictor of long-term acute heart failure, major adverse CV events, and all-cause mortality. These findings underscore the importance of early identification of CV complications and stricter long-term follow-up for chronic kidney disease patients undergoing aortoiliac revascularization.

KEY WORDS: Peripheral arterial disease; Cardiovascular diseases; Arterial occlusive diseases; Heart disease risk factors; Survival analysis; Perioperative care