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Prognostic impact of preoperative serum alkaline phosphatase level on a composite of morbidity and mortality after thoracic endovascular aortic repair: A retrospective study

 Sung Yeon Ham  ;  Sang Beom Nam  ;  Dong Woo Han  ;  Ann Hee You  ;  Won Sik Lim  ;  Young Song 
 MEDICINE, Vol.98(38) : e17173, 2019 
Journal Title
Issue Date
Alkaline Phosphatase/blood* ; Aneurysm, Dissecting/diagnosis ; Aneurysm, Dissecting/mortality ; Aneurysm, Dissecting/surgery ; Aorta, Thoracic/surgery* ; Aortic Aneurysm, Thoracic/diagnosis ; Aortic Aneurysm, Thoracic/mortality ; Aortic Aneurysm, Thoracic/surgery ; Endovascular Procedures/adverse effects* ; Endovascular Procedures/mortality ; Female ; Humans ; Male ; Middle Aged ; Preoperative Period ; Prognosis ; Retrospective Studies ; Risk Factors ; Treatment Outcome
BACKGROUND: Serum alkaline phosphatase (ALP) is related to vascular calcification and is known to have a prognostic impact in various cohorts. However, evidence in patients undergoing thoracic endovascular aortic repair (TEVAR) is lacking. Thus, we hypothesized that preoperative serum ALP level could be used for predicting adverse events after TEVAR.

METHODS: We retrospectively reviewed 167 patients who underwent TEVAR between February 2013 and December 2016. Patients were classified into tertiles according to preoperative ALP level (<69, 69-92, and >92 IU/L). The composite of morbidity and mortality (composite MM) was defined as the presence of one or more of the following: myocardial infarction, cerebrovascular accident, dialysis requirement, pulmonary complication, infection, and mortality within 1 year after TEVAR. The incidence of composite MM was compared among the 3 tertiles, and stepwise logistic regression analysis was performed to evaluate the predictors for composite MM.

RESULTS: The incidence of composite MM was 14.5% in the first tertile group, 17.9% in the second tertile group, and 35.7% in the third tertile group (P = .016). The third tertile of ALP level (odds ratio [OR] 1.766, 95% confidence interval [CI] 1.074-2.904, P = .025) and emergency TEVAR (OR 2.369, 95% CI 1.050-5.346, P = .038) remained as independent predictors of composite MM.

CONCLUSIONS: Our data showed an independent relationship between high preoperative ALP levels and adverse outcomes in patients undergoing TEVAR. This finding might suggest a potential role of ALP level as a risk stratification marker.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Nam, Sang Beom(남상범) ORCID logo https://orcid.org/0000-0002-9704-1866
Song, Young(송영) ORCID logo https://orcid.org/0000-0003-4597-387X
Han, Dong Woo(한동우) ORCID logo https://orcid.org/0000-0002-8757-663X
Ham, Sung Yeon(함성연) ORCID logo https://orcid.org/0000-0001-8619-4595
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