Annals of vascular surgery · 2026
Development and Internal Validation of the Si-AAA Prognostic Score for Five-Year Overall Survival after Endovascular Aneurysm Repair in Patients with Asymptomatic Abdominal Aortic Aneurysm.
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Prapassaro Tossapol, Jitcharoen Natwadee, Chinsakchai Khamin, Tongsai Sasima, Hongku Kiattisak, Wongwanit Chumpol, Sermsathanasawadi Nuttawut, Hahtapornsawan Suteekhanit, Puangpunngam Nattawut, Pruekprasert Kanin, Chaisongrit Tiwa, Ruangsetakit Chanean
Аннотация
BACKGROUND: Although endovascular aneurysm repair is widely used for the treatment of asymptomatic abdominal aortic aneurysm, long-term survival is influenced by patient comorbidities and aneurysm-related characteristics. This study aimed to develop and internally validate a prognostic scoring system for predicting 5-year overall survival after endovascular aneurysm repair.
METHODS: A retrospective cohort study was conducted in patients with asymptomatic abdominal aortic aneurysm undergoing endovascular aneurysm repair. Candidate predictors included demographic, clinical, aneurysm-related, and laboratory variables. Multivariable Cox proportional hazards regression was used to identify independent predictors of 5-year mortality. Continuous predictors were categorized using clinically interpretable thresholds derived from time-dependent receiver operating characteristic analysis, and a simplified point-based score was constructed from regression coefficients. Model performance was assessed using Harrell's concordance index, and internal validation was performed using 1,000 bootstrap resamples to obtain an optimism-corrected concordance index. Calibration was evaluated using bootstrap-based calibration plots.
RESULTS: A total of 445 patients were screened, and 443 complete cases were included in the final analysis. During follow-up, 133 deaths (30.0%) occurred. The estimated 5-year overall survival rate was 62.8% (95% CI, 57.8%-68.0%). Independent predictors of 5-year mortality included age >70 years (adjusted hazard ratio [aHR] 1.66, 95% CI 1.06-2.62; P = .029), chronic obstructive pulmonary disease (aHR 1.70, 95% CI 1.08-2.69; P = .023), unfit status (aHR 2.32, 95% CI 1.58-3.39; P < .001), serum albumin ≤3.5 g/dL (aHR 2.80, 95% CI 1.97-3.98; P < .001), and abdominal aortic aneurysm diameter ≥7 cm (aHR 1.59, 95% CI 1.07-2.38; P = .023). The final score ranged from 0 to 7. The apparent concordance index was 0.721, with an optimism-corrected concordance index of 0.713 after bootstrap validation. Risk stratification showed clear separation between low-, intermediate-, and high-risk groups (5-year overall survival: 82.5%, 53.4%, and 23.8%, respectively; log-rank P < .001).
CONCLUSIONS: A simple prognostic scoring system incorporating age, chronic obstructive pulmonary disease, unfit status, serum albumin, and aneurysm diameter demonstrated acceptable discrimination and good calibration for predicting 5-year overall survival after endovascular aneurysm repair. This tool may assist in risk stratification and long-term clinical decision-making. As this score was derived and internally validated in a single-center cohort, external validation in independent cohorts is required before routine clinical implementation.
METHODS: A retrospective cohort study was conducted in patients with asymptomatic abdominal aortic aneurysm undergoing endovascular aneurysm repair. Candidate predictors included demographic, clinical, aneurysm-related, and laboratory variables. Multivariable Cox proportional hazards regression was used to identify independent predictors of 5-year mortality. Continuous predictors were categorized using clinically interpretable thresholds derived from time-dependent receiver operating characteristic analysis, and a simplified point-based score was constructed from regression coefficients. Model performance was assessed using Harrell's concordance index, and internal validation was performed using 1,000 bootstrap resamples to obtain an optimism-corrected concordance index. Calibration was evaluated using bootstrap-based calibration plots.
RESULTS: A total of 445 patients were screened, and 443 complete cases were included in the final analysis. During follow-up, 133 deaths (30.0%) occurred. The estimated 5-year overall survival rate was 62.8% (95% CI, 57.8%-68.0%). Independent predictors of 5-year mortality included age >70 years (adjusted hazard ratio [aHR] 1.66, 95% CI 1.06-2.62; P = .029), chronic obstructive pulmonary disease (aHR 1.70, 95% CI 1.08-2.69; P = .023), unfit status (aHR 2.32, 95% CI 1.58-3.39; P < .001), serum albumin ≤3.5 g/dL (aHR 2.80, 95% CI 1.97-3.98; P < .001), and abdominal aortic aneurysm diameter ≥7 cm (aHR 1.59, 95% CI 1.07-2.38; P = .023). The final score ranged from 0 to 7. The apparent concordance index was 0.721, with an optimism-corrected concordance index of 0.713 after bootstrap validation. Risk stratification showed clear separation between low-, intermediate-, and high-risk groups (5-year overall survival: 82.5%, 53.4%, and 23.8%, respectively; log-rank P < .001).
CONCLUSIONS: A simple prognostic scoring system incorporating age, chronic obstructive pulmonary disease, unfit status, serum albumin, and aneurysm diameter demonstrated acceptable discrimination and good calibration for predicting 5-year overall survival after endovascular aneurysm repair. This tool may assist in risk stratification and long-term clinical decision-making. As this score was derived and internally validated in a single-center cohort, external validation in independent cohorts is required before routine clinical implementation.