使用VQI数据库研究颈动脉血运重建术后卒中和心肌梗死对1年生存率的影响。

IF 1.6 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Ahmed Abdelkarim, Mohammed Hamouda, Mohamed Abdalla, Sina Zarrintan, Jesse A Columbo, Mahmoud B Malas
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引用次数: 0

摘要

目的:术后卒中和心肌梗死(MI)与破坏性的术后发病率和死亡率相关,因此限制了颈动脉血运重建术的保护作用。此外,中风的严重程度似乎与颈动脉血管重建术的类型有关。我们的目的是研究院内卒中或心肌梗死对颈动脉内膜切除术(CEA)、经股动脉支架置入术(TFCAS)和经颈动脉重建术(TCAR)后一年生存率的影响。方法:回顾性分析VQI数据库(2016-2023)中接受CEA、TFCAS和TCAR治疗的患者。我们的主要结局是颈动脉血管重建术后发生院内卒中或心肌梗死的患者一年死亡率。在调整潜在混杂因素后,应用Kaplan-Meier生存估计和多变量Cox回归分析计算风险比(HR)。此外,我们还根据患者的症状状态进行了亚组分析。结果:我们的研究纳入了125,513例(61.8%)CEA, 25,875例(12.8%)TFCAS和51,545例(25.4%)TCAR。与术后未发生卒中的患者相比,CEA后发生卒中的患者1年死亡风险更高(校正风险比[aHR] = 5.9[95%CI:5.1-6.8])。结论:这项大型多中心研究揭示了住院主要不良事件对颈动脉血运重建术后1年生存率的影响。分析表明,院内卒中和心肌梗死后1年死亡率的风险显著增加。在发生院内卒中或心肌梗死的患者中,TCAR和CEA的1年生存率无显著差异。相反,在发生院内卒中或心肌梗死的患者中,与CEA和TCAR相比,TFCAS与更高的死亡率相关。本研究强调了为每位患者选择合适的血运重建方法以提高一年生存率的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Impact of Postoperative Stroke and Myocardial Infarction on One-Year Survival Following Carotid Revascularization Using the VQI Database.

Objective: Postoperative stroke and myocardial infarction (MI) are associated with devastating postoperative morbidity and mortality, therefore limiting the protective effect of carotid revascularization procedures. Moreover, there seems to be a relationship between the severity of stroke and the type of carotid revascularization technique. We aim to investigate the impact of in-hospital stroke or MI on one-year survival following carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR).

Methods: This is a retrospective analysis of patients undergoing CEA, TFCAS, and TCAR in the VQI database (2016-2023). Our primary outcome was one-year mortality in patients who developed in-hospital stroke or MI following carotid revascularization. Kaplan-Meier survival estimate and multivariable Cox regression analysis were applied to calculate hazard ratios (HR) after adjusting for potential confounders. Additionally, we conducted sub-analyses based on patients' symptomatic status.

Results: Our study included 125,513 (61.8%) CEA, 25,875 (12.8%) TFCAS, and 51,545 (25.4%) TCAR. Compared to patients who did not have a postoperative stroke, the hazard of 1-year mortality was higher for those who did have a stroke following CEA (adjusted hazards ratio [aHR] = 5.9[95%CI:5.1-6.8] P<0.001), TFCAS (aHR=4.2[95%CI:3.7-5.3] P<0.001), and TCAR (aHR=5.2[95%CI:4.1-6.5] P<0.001). The hazards of 1-year mortality after in-hospital MI were also higher following CEA (aHR=3.8[95%CI:3.1- 4.6] P<0.001), TFCAS (aHR=3.5[95%CI:2.3- 5.5] P<0.001), and TCAR (aHR=5.1[95%CI:3.6- 7.2] P<0.001). This trend persisted in sub-analysis based on symptomatic status. At one year, TFCAS showed the lowest survival following an in-hospital stroke or MI. There was no significant difference in one-year mortality among patients who developed in-hospital stroke between TCAR and CEA (aHR=0.93[95%CI:0.73- 1.2] P=0.55). On the other hand, TFCAS was associated with a 50% higher mortality hazard than CEA (aHR=1.5[95%CI:1.1-2.1] P=0.003), and TCAR was associated with a 30% reduction in one-year mortality compared to TFCAS (aHR=0.7[95%CI:0.55-0.94] P=0.015) among patients who developed in-hospital stroke.

Conclusion: This large multicenter study reveals critical insights into the impact of in-hospital major adverse events on one-year survival following carotid revascularization. The analysis indicates a significant increase in the hazard of one-year mortality following in-hospital stroke and MI. In patients who developed in-hospital stroke or MI, there was no significant difference in one-year survival between TCAR and CEA. On the contrary, among patients who developed in-hospital stroke or MI, TFCAS was associated with significantly higher mortality compared to CEA and TCAR. This study highlights the importance of selecting the appropriate revascularization method for each patient to improve one-year survival.

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来源期刊
CiteScore
3.00
自引率
13.30%
发文量
603
审稿时长
50 days
期刊介绍: Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal: Clinical Research (reports of clinical series, new drug or medical device trials) Basic Science Research (new investigations, experimental work) Case Reports (reports on a limited series of patients) General Reviews (scholarly review of the existing literature on a relevant topic) Developments in Endovascular and Endoscopic Surgery Selected Techniques (technical maneuvers) Historical Notes (interesting vignettes from the early days of vascular surgery) Editorials/Correspondence
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