{"title":"胸腔内血管主动脉修补术后非高血压主动脉夹层患者的临床特征和生存分析：一项为期 10 年的回顾性研究。","authors":"Shuangshuang Li, Xianfei Liu, Jin Yang, Zilin Lu, Jian Dong, Jia He, Jian Zhou","doi":"10.21037/jtd-24-318","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The clinical characteristics and predictors for aortic adverse events (AAEs) after thoracic endovascular aortic repair (TEVAR) of non-hypertensive aortic dissection (AD) patients remain unclear. This study sought to clarify the clinical features of non-hypertensive AD and its incidence of AAEs after TEVAR.</p><p><strong>Methods: </strong>Clinical data were collected from the electronic medical records, imaging databases and follow-up. Baseline characteristics were balanced by propensity score matching (PSM). Kaplan-Meier analysis and Cox proportional hazards regression analysis were performed to asses postoperative AAEs and risk factors.</p><p><strong>Results: </strong>Eight hundred and eighty-eight eligible AD patients who had received TEVAR were included. The proportion of males (72.2% <i>vs.</i> 80.6%, P=0.006) and the mean age of onset (55.17±14.95 <i>vs.</i> 59.08±13.34 years, P=0.001) were lower in the non-hypertension group. Type A dissection still accounted for a higher proportion in the non-hypertensive group than the hypertensive group (38.2% <i>vs.</i> 28.3%, P=0.02) after matching. Non-hypertensive AD showed a lower mean survive time (36.65±2.08 <i>vs.</i> 42.74±1.41 months, P=0.01) with a higher 5-year adverse event ratio (37.4% <i>vs.</i> 29.0%, P=0.05). Hazard ratio (HR) of type A dissection, international normalized ratio (INR), prothrombin time (PT), aortic root diameter (AoRoot) and left ventricular volume associated with AAEs after TEVAR were 3.348 [95% confidence interval (CI): 2.313-4.846], 269.197 (95% CI: 3.46-20,946.462), 0.595 (95% CI: 0.369-0.959), 2.446 (95% CI: 1.542-3.880), 1.008 (95% CI: 1.004-1.012), respectively.</p><p><strong>Conclusions: </strong>Non-hypertensive patients presented a higher proportion of female and type A classification, and a younger mean age of TEVAR treatment. Preoperative indicators including Stanford classification, PT, activated partial thromboplastin time (APTT), AoRoot and left ventricular volume were major risk factors for adverse events after TEVAR, which deserve to be further explored and evaluated for its predictive value for better management of AD.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7397-7407"},"PeriodicalIF":2.1000,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635238/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical features and survival analysis of non-hypertensive aortic dissection patients post-thoracic endovascular aortic repair: a 10-year retrospective study.\",\"authors\":\"Shuangshuang Li, Xianfei Liu, Jin Yang, Zilin Lu, Jian Dong, Jia He, Jian Zhou\",\"doi\":\"10.21037/jtd-24-318\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The clinical characteristics and predictors for aortic adverse events (AAEs) after thoracic endovascular aortic repair (TEVAR) of non-hypertensive aortic dissection (AD) patients remain unclear. This study sought to clarify the clinical features of non-hypertensive AD and its incidence of AAEs after TEVAR.</p><p><strong>Methods: </strong>Clinical data were collected from the electronic medical records, imaging databases and follow-up. Baseline characteristics were balanced by propensity score matching (PSM). Kaplan-Meier analysis and Cox proportional hazards regression analysis were performed to asses postoperative AAEs and risk factors.</p><p><strong>Results: </strong>Eight hundred and eighty-eight eligible AD patients who had received TEVAR were included. The proportion of males (72.2% <i>vs.</i> 80.6%, P=0.006) and the mean age of onset (55.17±14.95 <i>vs.</i> 59.08±13.34 years, P=0.001) were lower in the non-hypertension group. Type A dissection still accounted for a higher proportion in the non-hypertensive group than the hypertensive group (38.2% <i>vs.</i> 28.3%, P=0.02) after matching. Non-hypertensive AD showed a lower mean survive time (36.65±2.08 <i>vs.</i> 42.74±1.41 months, P=0.01) with a higher 5-year adverse event ratio (37.4% <i>vs.</i> 29.0%, P=0.05). Hazard ratio (HR) of type A dissection, international normalized ratio (INR), prothrombin time (PT), aortic root diameter (AoRoot) and left ventricular volume associated with AAEs after TEVAR were 3.348 [95% confidence interval (CI): 2.313-4.846], 269.197 (95% CI: 3.46-20,946.462), 0.595 (95% CI: 0.369-0.959), 2.446 (95% CI: 1.542-3.880), 1.008 (95% CI: 1.004-1.012), respectively.</p><p><strong>Conclusions: </strong>Non-hypertensive patients presented a higher proportion of female and type A classification, and a younger mean age of TEVAR treatment. Preoperative indicators including Stanford classification, PT, activated partial thromboplastin time (APTT), AoRoot and left ventricular volume were major risk factors for adverse events after TEVAR, which deserve to be further explored and evaluated for its predictive value for better management of AD.</p>\",\"PeriodicalId\":17542,\"journal\":{\"name\":\"Journal of thoracic disease\",\"volume\":\"16 11\",\"pages\":\"7397-7407\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-11-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635238/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of thoracic disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/jtd-24-318\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/29 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of thoracic disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/jtd-24-318","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/29 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
摘要
背景：非高血压主动脉夹层（AD）患者胸腔内血管主动脉修补术（TEVAR）后主动脉不良事件（AAEs）的临床特征和预测因素仍不清楚。本研究旨在明确非高血压主动脉夹层的临床特征及其在 TEVAR 术后 AAE 的发生率：从电子病历、影像数据库和随访中收集临床数据。通过倾向评分匹配（PSM）平衡基线特征。对术后AAEs和风险因素进行Kaplan-Meier分析和Cox比例危险回归分析：结果：共纳入了88名符合条件的接受过TEVAR的AD患者。非高血压组的男性比例（72.2% vs. 80.6%，P=0.006）和平均发病年龄（55.17±14.95 vs. 59.08±13.34岁，P=0.001）均较低。匹配后，非高血压组 A 型夹层所占比例仍高于高血压组（38.2% 对 28.3%，P=0.02）。非高血压 AD 平均存活时间较短（36.65±2.08 个月 vs. 42.74±1.41个月，P=0.01），5年不良事件比率较高（37.4% vs. 29.0%，P=0.05）。TEVAR后与AAEs相关的A型夹层、国际标准化比值（INR）、凝血酶原时间（PT）、主动脉根部直径（AoRoot）和左心室容积的危险比（HR）分别为3.348[95%置信区间（CI）：2.313-4.846]、269.197（95% CI：3.46-20,946.462）、0.595（95% CI：0.369-0.959）、2.446（95% CI：1.542-3.880）、1.008（95% CI：1.004-1.012）：结论：非高血压患者中女性和A型分类的比例更高，TEVAR治疗的平均年龄更小。术前指标包括斯坦福分级、PT、活化部分凝血活酶时间（APTT）、AoRoot和左心室容积是TEVAR术后不良事件的主要风险因素，值得进一步探讨和评估其预测价值，以便更好地管理AD。
Clinical features and survival analysis of non-hypertensive aortic dissection patients post-thoracic endovascular aortic repair: a 10-year retrospective study.
Background: The clinical characteristics and predictors for aortic adverse events (AAEs) after thoracic endovascular aortic repair (TEVAR) of non-hypertensive aortic dissection (AD) patients remain unclear. This study sought to clarify the clinical features of non-hypertensive AD and its incidence of AAEs after TEVAR.
Methods: Clinical data were collected from the electronic medical records, imaging databases and follow-up. Baseline characteristics were balanced by propensity score matching (PSM). Kaplan-Meier analysis and Cox proportional hazards regression analysis were performed to asses postoperative AAEs and risk factors.
Results: Eight hundred and eighty-eight eligible AD patients who had received TEVAR were included. The proportion of males (72.2% vs. 80.6%, P=0.006) and the mean age of onset (55.17±14.95 vs. 59.08±13.34 years, P=0.001) were lower in the non-hypertension group. Type A dissection still accounted for a higher proportion in the non-hypertensive group than the hypertensive group (38.2% vs. 28.3%, P=0.02) after matching. Non-hypertensive AD showed a lower mean survive time (36.65±2.08 vs. 42.74±1.41 months, P=0.01) with a higher 5-year adverse event ratio (37.4% vs. 29.0%, P=0.05). Hazard ratio (HR) of type A dissection, international normalized ratio (INR), prothrombin time (PT), aortic root diameter (AoRoot) and left ventricular volume associated with AAEs after TEVAR were 3.348 [95% confidence interval (CI): 2.313-4.846], 269.197 (95% CI: 3.46-20,946.462), 0.595 (95% CI: 0.369-0.959), 2.446 (95% CI: 1.542-3.880), 1.008 (95% CI: 1.004-1.012), respectively.
Conclusions: Non-hypertensive patients presented a higher proportion of female and type A classification, and a younger mean age of TEVAR treatment. Preoperative indicators including Stanford classification, PT, activated partial thromboplastin time (APTT), AoRoot and left ventricular volume were major risk factors for adverse events after TEVAR, which deserve to be further explored and evaluated for its predictive value for better management of AD.
期刊介绍：
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.
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