Protack Clinton D, Bakken Andrew M, Xu Jiaqiong, Saad Wael A, Lumsden Alan B, Davies Mark G
Methodist DeBakey Heart and Vascular Center, Department of Cardiovascular Surgery, The Methodist Hospital, Houston, TX 77030, USA.
J Vasc Surg. 2009 May;49(5):1172-80.e1; discussion 1180. doi: 10.1016/j.jvs.2008.12.011.
Metabolic syndrome (MetS) is rapidly increasing in prevalence and is associated with carotid plaque development and is a risk factor for stroke. The aim of this study is to describe the outcomes for patients with MetS after carotid revascularization (carotid endarterectomy [CEA] and carotid stenting [CAS]).
A database of patients undergoing carotid revascularization for primary atherosclerotic lesions was queried from 1996 to 2006. MetS was defined as the presence of >or=3 of the following criteria: blood pressure >or=130 mm Hg/>or=90 mm Hg; Triglycerides >or=150 mg/dL; high-density lipoproteins (HDL) <or=50 mg/dL for women and <or=40 mg/dL for men; fasting blood glucose >or=110 mg/dL; or Body Mass Index (BMI) >or=30 kg/m(2). Multivariate and Kaplan-Meier analyses were performed to outcomes. The average follow-up period was 4.5 years. A major adverse event (MAE) was defined as the occurrence of stroke, myocardial infarction (MI), or death.
A total of 921 patients (mean age: 71 +/- 10 years; 64% male) underwent 750 CEAs and 171 CAS. Thirty-one percent were identified as having MetS, 48% were asymptomatic, 87% had hypertension, 27% had hyperlipidemia, 32% were considered diabetic, and 14% had chronic renal insufficiency. The morbidity and mortality rates for all patients were 16.9% and 1.1%, respectively. The 30-day combined stroke/death rate was 3.6%. The 30-day MAE rates were: 6.7% vs 3.3% for MetS vs No-MetS (P = .02). The 90-day MAE rates were 8.7% vs 4.9% for MetS vs No-MetS (P = .03). MetS patients were more likely to experience a complication than No-MetS patients (23% vs 14%, P = .001). By Kaplan-Meier analysis, there was no difference between MetS and No-MetS patients with respect to patency, restenosis, re-intervention, or survival, but a difference existed for freedom from stroke, MI, and MAE. The difference between stroke rates was maintained between MetS and No-MetS, when subgrouped by those with and without symptoms. For patients with diabetes mellitus (DM), those with MetS had a 68% and 410% higher risk of developing an MAE and MI, respectively. However, for patients without diabetes, MetS was not significantly associated with MAE, stroke, or MI. No factors were found to be significantly associated with risk of stroke in all cases (in all patients, patients with diabetes, and patients without diabetes).
MetS is prevalent among patients undergoing carotid revascularization. MetS patients are at a greater risk for perioperative morbidity as well as stroke, MI, and MAE during follow-up when compared to patients without MetS. Long-term stroke prevention is poor in the presence of MetS. MetS should be considered a significant risk factor for patients undergoing carotid revascularization.
代谢综合征（MetS）的患病率正在迅速上升，与颈动脉斑块形成相关，是中风的危险因素。本研究的目的是描述接受颈动脉血运重建术（颈动脉内膜切除术[CEA]和颈动脉支架置入术[CAS]）的MetS患者的预后情况。
查询1996年至2006年因原发性动脉粥样硬化病变接受颈动脉血运重建术的患者数据库。MetS定义为存在以下标准中的≥3项：血压≥130 mmHg/≥90 mmHg；甘油三酯≥150 mg/dL；高密度脂蛋白（HDL）女性≤50 mg/dL，男性≤40 mg/dL；空腹血糖≥110 mg/dL；或体重指数（BMI）≥30 kg/m²。对预后进行多变量分析和Kaplan-Meier分析。平均随访期为4.5年。主要不良事件（MAE）定义为中风、心肌梗死（MI）或死亡的发生。
共有921例患者（平均年龄：71±10岁；64%为男性）接受了750例CEA和171例CAS。31%的患者被确定患有MetS，48%无症状，87%患有高血压，27%患有高脂血症，32%被认为患有糖尿病，14%患有慢性肾功能不全。所有患者的发病率和死亡率分别为16.9%和1.1%。30天的中风/死亡率为3.6%。30天的MAE发生率为：MetS患者为6.7%，非MetS患者为3.3%（P = 0.02）。90天的MAE发生率为：MetS患者为8.7%，非MetS患者为4.9%（P = 0.03）。与非MetS患者相比，MetS患者更有可能发生并发症（23%对14%，P = 0.001）。通过Kaplan-Meier分析，在通畅率、再狭窄、再次干预或生存率方面，MetS患者和非MetS患者之间没有差异，但在无中风、MI和MAE方面存在差异。当按有无症状进行亚组分析时，MetS患者和非MetS患者之间的中风率差异仍然存在。对于糖尿病（DM）患者，患有MetS的患者发生MAE和MI的风险分别高68%和410%。然而，对于非糖尿病患者，MetS与MAE、中风或MI无显著关联。在所有病例（所有患者、糖尿病患者和非糖尿病患者）中，均未发现与中风风险显著相关的因素。
MetS在接受颈动脉血运重建术的患者中很常见。与非MetS患者相比，MetS患者围手术期发病率以及随访期间中风、MI和MAE的风险更高。在存在MetS的情况下，长期中风预防效果较差。MetS应被视为接受颈动脉血运重建术患者的一个重要危险因素。
