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Outcomes of abdominal aortic aneurysm repair among patients with rheumatoid arthritis

Salata K, Almaghlouth I, Hussain MA, de Mestral C, Greco E, Aljabri BA, Mamdani M, Forbes TL, Verma S, Al-Omran M. J Vasc Surg. 2021; 73(4):1261-8.e5. Epub 2020 Sep 17. DOI:

Objective — This study aimed to compare the outcomes of elective abdominal aortic aneurysm (AAA) repair in rheumatoid arthritis (RA) patients versus those without RA stratified by type of surgery.

Methods — A retrospective population-based cohort study was conducted from 2003 to 2016. Linked administrative health data from Ontario, Canada were used to identify all patients >65 years of age that underwent elective open or endovascular AAA repair during the study period. Patients were identified using validated procedure and billing codes, and were propensity scored matched. The primary outcome was survival. Secondary outcomes were major adverse cardiovascular event free survival, defined as freedom from death, myocardial infarction or stroke; reintervention; and secondary rupture.

Results — From 14,816 elective AAA repair patients, a diagnosis of RA was present in 309 (2.0%). The propensity matched cohort included 234 pairs of RA and control patients. The matched cohort was followed for a mean 4.93 years (SD 3.35), and median survival was 6.76 and 7.31 years among RA and control patients. Cox regression analysis demonstrated no statistically significant differences in hazards for death, MACE, reintervention or secondary rupture. Analysis for differences in outcomes by repair approach also showed no statistically significant differences in the hazards for death, MACE, reintervention, or secondary rupture.

Conclusion — There were no statistically significant differences in survival, MACE, reintervention, or secondary rupture among elective AAA repair patients with RA compared to controls. Further studies are required to evaluate the impact of comorbidities and anti-rheumatic medications on the outcomes of elective AAA repair.