Durham Christopher A, Ehlert Bryan A, Agle Steven C, Mays Ashley C, Parker Frank M, Bogey William M, Powell Charles S, Stoner Michael C
Department of Surgery, East Carolina University, Greenville, NC 27858-4354, USA.
Ann Vasc Surg. 2012 Apr;26(3):344-52. doi: 10.1016/j.avsg.2011.10.010. Epub 2012 Jan 30.
The purpose of this study was to evaluate the 10-year outcome of patients presenting with asymptomatic moderate carotid artery stenosis, and to determine which factors correlate with progression of disease to stroke or revascularization.
A retrospective review of all new patients presenting with asymptomatic moderate carotid artery stenosis from July 1998 to December 2001 was undertaken. Patients were consecutively identified and included by using duplex ultrasonography to identify moderate carotid disease. Variables were recorded for all patient encounters through June 2010. The primary end point was occurrence of ipsilateral cerebrovascular stroke or revascularization event (SORE). Statin therapy and angiotensin blockade (STAB) were categorized as follows: STAB(0)-medical treatment with neither statin therapy nor angiotensin blockade, STAB(1)-treatment with only one of the two, STAB(2)-treatment with both. An amortized cost model analyzed the cost of SORE-free survival.
Over a 42-month period, 468 carotids in 366 patients with an average age of 69.0 ± 8.7 years were evaluated. Over a mean follow-up of 6.6 ± 2.7 years, SORE occurred in 150 (32.1%) carotid arteries. Hyperlipidemia was predictive of SORE (hazard ratio [HR]: 1.543, 95% confidence interval [CI]: 1.053-2.262, P = 0.03). Medical therapies protective against SORE were beta-blockade (HR: 0.612, 95% CI: 0.435-0.861, P < 0.05), STAB(1) (HR: 0.487, 95% CI: 0.336-0.706, P < 0.01), and STAB(2) (HR: 0.149, 95% CI: 0.089-0.248, P < 0.01). At 10 years, SORE-free survival in STAB(2) was 82.7% ± 4.6%, STAB(1) was 56.3% ± 5.0%, and STAB(0) was 29.3% ± 5.4% (P < 0.01). The cost per SORE-free year in STAB(2) was $1,695.40 ± $275.60, STAB(1) was $3,916.80 ± $605.44, and STAB(0) was $4,126.40 ± $427.23 (P < 0.01).
These data demonstrate the clinical and financial advantage of using both statin therapy and angiotensin pathway blockage in patients with asymptomatic moderate carotid artery stenosis.
本研究旨在评估无症状性中度颈动脉狭窄患者的10年预后，并确定哪些因素与疾病进展至中风或血管重建相关。
对1998年7月至2001年12月期间所有出现无症状性中度颈动脉狭窄的新患者进行回顾性研究。通过使用双功超声识别中度颈动脉疾病，连续识别并纳入患者。记录截至2010年6月所有患者就诊时的变量。主要终点是同侧脑血管中风或血管重建事件（SORE）的发生。他汀类药物治疗和血管紧张素阻断（STAB）分类如下：STAB(0) - 既未接受他汀类药物治疗也未接受血管紧张素阻断的药物治疗，STAB(1) - 仅接受两者之一的治疗，STAB(2) - 接受两者的治疗。一个摊销成本模型分析了无SORE生存的成本。
在42个月期间，对366例平均年龄为69.0±8.7岁患者的468条颈动脉进行了评估。平均随访6.6±2.7年，150条（32.1%）颈动脉发生了SORE。高脂血症是SORE的预测因素（风险比[HR]：1.543，95%置信区间[CI]：1.053 - 2.262，P = 0.03）。预防SORE的药物治疗包括β受体阻滞剂（HR：0.612，95% CI：0.435 - 0.861，P < 0.05）、STAB(1)（HR：0.487，95% CI：0.336 - 0.706，P < 0.01）和STAB(2)（HR：0.149，95% CI：0.089 - 0.248，P < 0.01）。10年时，STAB(2)组的无SORE生存率为82.7%±4.6%，STAB(1)组为56.3%±5.0%，STAB(0)组为29.3%±5.4%（P < 0.01）。STAB(2)组每无SORE年的成本为1,695.40美元±275.60美元，STAB(1)组为3,916.80美元±605.44美元，STAB(0)组为4,126.40美元±427.23美元（P < 0.01）。
这些数据表明，在无症状性中度颈动脉狭窄患者中同时使用他汀类药物治疗和血管紧张素途径阻断具有临床和经济优势。
