Welten Gijs M J M, Schouten Olaf, Hoeks Sanne E, Chonchol Michel, Vidakovic Radosav, van Domburg Ron T, Bax Jeroen J, van Sambeek Marc R H M, Poldermans Don
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
J Am Coll Cardiol. 2008 Apr 22;51(16):1588-96. doi: 10.1016/j.jacc.2007.11.077.
This study was designed to compare the long-term outcomes of patients with peripheral arterial disease (PAD) with a risk factor matched population of coronary artery disease (CAD) patients, but without PAD.
The PAD is considered to be a risk factor for adverse late outcome.
A total of 2,730 PAD patients undergoing vascular surgery were categorized into groups: 1) carotid endarterectomy (n = 560); 2) elective abdominal aortic surgery (AAA) (n = 923); 3) acute AAA surgery (r-AAA) (n = 200), and 4) lower limb reconstruction procedures (n = 1,047). All patients were matched using the propensity score, with 2,730 CAD patients who underwent coronary angioplasty. Survival status of all patients was obtained. In addition, the cause of death and complications after surgery in PAD patients were noted. The Kaplan-Meier method was used to compare survival between the matched PAD and CAD population and the different operation groups. Prognostic risk factors and perioperative complications were identified with the Cox proportional hazards regression model.
The PAD patients had a worse long-term prognosis (hazard ratio 2.40, 95% confidence interval 2.18 to 2.65) and received less medication (beta-blockers, statins, angiotensin-converting enzyme inhibitors, aspirin, nitrates, and calcium antagonists) than CAD patients did (p < 0.001). Cerebro-cardiovascular complications were the major cause of long-term death (46%). Importantly, no significant difference in long-term survival was observed between the AAA and lower limb reconstruction groups (log rank p = 0.70). After vascular surgery, perioperative cardiac complications were associated with long-term cardiac death, and noncardiac complications were associated with all-cause death.
Long-term prognosis of vascular surgery patients is significantly worse than for patients with CAD. The vascular surgery patients receive less cardiac medication than CAD patients do, and cerebro-cardiovascular events are the major cause of late death.
本研究旨在比较外周动脉疾病（PAD）患者与匹配的无PAD的冠状动脉疾病（CAD）患者群体的长期预后。
PAD被认为是不良晚期结局的一个危险因素。
总共2730例接受血管手术的PAD患者被分为以下几组：1）颈动脉内膜切除术（n = 560）；2）择期腹主动脉手术（AAA）（n = 923）；3）急性AAA手术（r - AAA）（n = 200）；4）下肢重建手术（n = 1047）。所有患者使用倾向评分进行匹配，与2730例接受冠状动脉成形术的CAD患者进行对照。获取所有患者的生存状态。此外，记录PAD患者术后的死亡原因和并发症。采用Kaplan - Meier方法比较匹配的PAD和CAD人群以及不同手术组之间的生存率。使用Cox比例风险回归模型确定预后危险因素和围手术期并发症。
与CAD患者相比，PAD患者的长期预后更差（风险比2.40，95%置信区间2.18至2.65），且接受的药物治疗（β受体阻滞剂、他汀类药物、血管紧张素转换酶抑制剂、阿司匹林、硝酸盐和钙拮抗剂）更少（p < 0.001）。心脑血管并发症是长期死亡的主要原因（46%）。重要的是，AAA组和下肢重建组之间在长期生存方面未观察到显著差异（对数秩检验p = 0.70）。血管手术后，围手术期心脏并发症与长期心脏死亡相关，非心脏并发症与全因死亡相关。
血管手术患者的长期预后明显比CAD患者差。血管手术患者接受的心脏药物治疗比CAD患者少，心脑血管事件是晚期死亡的主要原因。
