Long-term survival after aortic aneurysm repair remains a significant challenge in cardiothoracic practice. A new analysis presented during the AHA Scientific Sessions 2025 indicates that lower circulating ApoA2 may help identify individuals at increased risk of long-term mortality after repair.

This cohort study included 203 adults who underwent successful repair of aortic aneurysm. During a median follow-up of 3.5 years, mortality occurred in 32 individuals (15.8%). ApoA2 concentrations were significantly lower in those who died [22.0 (19.0, 25.0) mg/dL] compared with survivors [25.0 (22.0, 29.0) mg/dL; P < .001].

ApoA2 showed inverse correlations with age, B-type natriuretic peptide (BNP), C-reactive protein (CRP), and fibrinogen, and a positive correlation with estimated glomerular filtration rate (eGFR). In multivariate Cox analysis, ApoA2 remained an independent mortality predictor (HR 0.92; 95% CI 0.86-0.99). Additional predictors included eGFR < 60 mL/min/1.73 m² (HR 3.49; 95% CI 1.49-8.20), chronic obstructive pulmonary disease (COPD) (HR 2.63; 95% CI 1.07-6.49), and thoracic aortic aneurysm (HR 2.54; 95% CI 1.25-5.18).

Risk prediction improved when ApoA2 was incorporated into baseline clinical factors (area under the curve [AUC] 0.79 vs 0.73; P = .04), indicating meaningful additional prognostic utility.

These findings support further evaluation of ApoA2 to refine postoperative monitoring and long-term care strategies among individuals undergoing aortic aneurysm repair.