A systematic review of the association between arterial calcification on preoperative imaging and clinical outcomes in peripheral arterial disease.

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Robbert B M Wiggers, Iris M Harmsen, Madeleine Kok, Joost A van Herwaarden, Pim A de Jong, Gert J de Borst, Constantijn E V B Hazenberg
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引用次数: 0

Abstract

Introduction: Peripheral arterial disease may lead to chronic limb-threatening ischemia, which is associated with major amputation and mortality. Early detection of patients at risk for poor outcomes could allow for patient-tailored prevention and treatment strategies, averting these adverse events. Coronary and aortic calcification have previously been shown to predict future cardiovascular events and mortality. The objective of this review was to investigate the association between peripheral artery calcification and clinical outcomes in symptomatic peripheral arterial disease patients, either in the natural course or after revascularization.

Data sources and review methods: A systematic search in PubMed, Embase and Cochrane CENTRAL up until 1 September 2024 yielded 2963 records. Studies were included if they (1) were written in English, (2) reported original data, (3) recruited symptomatic peripheral arterial disease patients (with claudication or chronic limb-threatening ischemia), (4) quantified arterial calcification in the infrarenal aorta and/or distal arteries with a calcium score based on preoperative or alternative non-invasive imaging and (5) compared clinical outcomes between patients with a range of quantitative or semiquantitative calcification assessments. Risk of bias was assessed using the QUIPS method.

Results and conclusion: 51 studies (N = 10 522 patients) met the inclusion criteria. 12 studies (N  = 1058) used quantitative scores, 37 used semiquantitative scores (N = 9208) and 2 used both (N = 256). Mean follow-up of included studies ranged between 6 and 46 months. A clear trend towards a higher rate of major adverse limb events, amputation, major adverse cardiovascular events and mortality was found with increasing calcium scores. However, relatively low sample sizes and heterogeneity in calcium scoring methods, patient population and performed interventions warrant cautious interpretation of these results. Further standardization of calcium scoring and follow-up studies in larger cohorts are needed to confirm these associations and facilitate implementation of calcium scoring in clinical practice.

外周动脉病变术前影像学与临床预后相关性的系统综述
外周动脉疾病可导致危及肢体的慢性缺血,这与重大截肢和死亡率相关。早期发现有不良预后风险的患者可以制定针对患者的预防和治疗策略,从而避免这些不良事件。冠状动脉和主动脉钙化已经被证明可以预测未来的心血管事件和死亡率。本综述的目的是调查有症状的外周动脉疾病患者的外周动脉钙化与临床结果之间的关系,无论是在自然过程中还是在血运重建术后。数据来源和回顾方法:系统检索PubMed, Embase和Cochrane CENTRAL,截至2024年9月1日,共获得2963条记录。纳入研究的条件是:(1)用英文撰写,(2)报道原始数据,(3)招募有症状的外周动脉疾病患者(伴有跛行或慢性肢体威胁性缺血),(4)根据术前或非侵入性影像学评分量化肾下主动脉和/或远端动脉的动脉钙化,以及(5)比较采用一系列定量或半定量钙化评估的患者的临床结果。采用QUIPS方法评估偏倚风险。结果与结论:51项研究(N = 10 522例)符合纳入标准。12项研究(N = 1058)采用定量评分法,37项研究(N = 9208)采用半定量评分法,2项研究两者兼用(N = 256)。纳入研究的平均随访时间为6至46个月。随着钙评分的增加,主要肢体不良事件、截肢、主要心血管不良事件和死亡率有明显的上升趋势。然而,相对较小的样本量和钙评分方法的异质性、患者群体和实施的干预措施需要谨慎解释这些结果。钙评分的进一步标准化和随访研究需要在更大的队列中证实这些关联,并促进钙评分在临床实践中的实施。
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来源期刊
CiteScore
7.70
自引率
18.60%
发文量
1469
审稿时长
54 days
期刊介绍: Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.
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