„SCAN“= Screening Cardiovascular patients for Aortic aNeurysms

Reutersberg B, Salvermoser M, Haller B, Schäffer C, Laugwitz KL, Eckstein HH

Department of Vascular and Endovascular Surgery andDepartment of CardiologyKlinikum rechts der Isar, Technical University of Munich

Department of Vascular and Endovascular Surgery

Disclosure

Speaker name:

...Benedikt Reutersberg, MD, FEBVS...............................................................

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s): Research grant from Medtronic and Faculty of Medicine,

Technical University of Munich (TUM)

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Department of Vascular and Endovascular Surgery

Background

The prevalence of AAA in men aged ≥ 65y ranges between 4-8% (⌀ 5.5%)

Patient-Screening: safe strategy to significantly reduce mortality and morbidity through elective surgery

In a preselected group, e.g. with certain risk factors (e.g. CHD), the value of screening could be significantly higher

Previous studies showed, that in patients with CHD the prevalence of AAA is ~ 2x higher (9.5% for ♂)

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Aim

The aim of this study was to identify a risk group that would benefit from a targeted AAA screening and to confirm previous findings.

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Methods

• Prospective study to assess the prevalence of AAA (≥ 3cm) in CHD patients at an university hospital.

• n = 1.000 consecutive male patients with CHD, who underwent coronary intervention, were screened between 4/2017-10/2018.

• An ultrasound scan of the abdominal aorta (outer-to-outer, leading edge and inner-to-inner) by one vascular surgeon

• Primary endpoint: prevalence of AAA compared to the general population

• Secondary endpoints: stratification in age groups and 1-, 2-, or 3-vessel-CHD

• Statistics: Student's t-test, chi-square test, multivariable logistic regression analysis, power analysis >90%, Binominal-Test,

LELEITI OTO Outer to Outer Inner to Inner

Leading edge

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Methods

• SCAN is a prospective study to assess the prevalence of AAA in CHD patients at an university hospital.

• We examined 1.000 consecutive male patients with CHD (age 70.1±11.2 years), who underwent coronary intervention, between 4/2017-10/2018.

• All patients received a transverse and longitudinal scan of the abdominal aorta.

• The primary endpoint was the prevalence of AAA in the study cohort.

• Secondary outcomes included stratification in 1-, 2-, or 3-vessel-CHD.

Inclusion criteria: ♂ patients, who underwent coronary-intervention

(PTCA/Stenting/CABG) At least one risk factor for AAA :

aHT, HLP, hyperuricemia, smoking, positive family history

Exclusion criteria: Life expectancy < 1 year Inability to follow investigator instructions

(Dementia, lack of time, lack of speech understanding) In-Compliance

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Without AAA With AAA

Outer-to-Outer, n (%) 915 (91.5) 85 (8.5)

Results:

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Without AAA With AAA

Outer-to-Outer, n (%) 915 (91.5) 85 (8.5)Leading edge, n (%) 929 (92.9) 71 (7.1)

Inner-to-Inner, n (%) 944 (95.9) 56 (5.6)

Results:

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Without AAA With AAA P

Outer-to-Outer, n (%) 915 (91.5) 85 (8.5)

Age, years, mean (SD) 69.8 ± 11.3 73.7 ± 8.4 <0.001Max. diameter, mm, median (range Q1-

Q3) 20 (18–22) 38 (33–48)

Results:

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Without AAA With AAA P

Outer-to-Outer, n (%) 915 (91.5) 85 (8.5)

Age, years, mean (SD) 69.8 ± 11.3 73.7 ± 8.4 <0.001Max. diameter, mm, median (range Q1-

Q3) 20 (18–22) 38 (33–48)

Results:

Unknown AAA, n (%) 49 (57.6)of wich required repair, n (%) 5 (5.9)

Known AAA, n (%) 36 (42.4)AAA repair in the past, n (%) 25 (29.4)

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Binominaltest against the 5.5% AAA-prevalence in the general population:

Outer-to-Outer: 8.5% vs. 5.5% p < 0.001

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Age distribution of patients with AAA

Orange line prevalence of AAA per age group.

p=0.006

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Correlation: No. of diseased coronary vessels and prevalence of AAA

p=0.037

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Without AAA(91.5%)

With AAA(8.5%)

P

BMI, mean (SD) 27.2 ± 4.6 26.8 ± 4.9 0.398

Arterial hypertension (%) 81.8 84.7 0.609

Hyperlipidemia (%) 66.9 83.1 0.004

Diabetes mellitus (%) 36.2 34.1 0.798

Hyperuricemia (%) 21.7 27.1 0.321

Never smokers (%) 28.3 9.4 <0.001

Positive family history (%) 39.5 42.7 0.659

Myocardial infarction (%) 64.6 62.4 0.775

Comorbidities and risk factors

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Without AAA(91.5%)

With AAA(8.5%)

P

Hyperlipidemia (%) 66.9 83.1 0.004

Never smokers (%) 28.3 9.4 <0.001

Comorbidities and risk factors

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Outer to Outer in comparison to Leading edge methode:

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Conclusions

SCAN reveals that CHD, requiring any type of intervention, is strongly associated with AAA in male patients.

The current study shows that the overall prevalence of 8.5% is significantly higher than in the general population.

The number of affected coronary arteries and increasing age correlates positively with the prevalence.

Our data confirm previous observational studies.

In the future, this risk group should also be offered participation in an ultrasound AAA screening program.

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Benedikt Reutersberg, MD, FEBVSbenedikt.reutersberg@gmail.com

Thank you very much!

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