早期主动脉瘤病不增加死亡率。
No increased mortality with early aortic aneurysm disease.
机构信息
Department of Surgery, Stanford University, Stanford, Calif, USA.
出版信息
J Vasc Surg. 2012 Nov;56(5):1246-51. doi: 10.1016/j.jvs.2012.04.023. Epub 2012 Jul 24.
OBJECTIVE
In addition to increased risks for aneurysm-related death, previous studies have determined that all-cause mortality in abdominal aortic aneurysm (AAA) patients is excessive and equivalent to that associated with coronary heart disease. These studies largely preceded the current era of coronary heart disease risk factor management, however, and no recent study has examined contemporary mortality associated with early AAA disease (aneurysm diameter between 3 and 5 cm). As part of an ongoing natural history study of AAA, we report the mortality risk associated with presence of early disease.
METHODS
Participants were recruited from three distinct health care systems in Northern California between 2006 and 2011. Aneurysm diameter, demographic information, comorbidities, medication history, and plasma for biomarker analysis were collected at study entry. Survival status was determined at follow-up. Data were analyzed with t-tests or χ(2) tests where appropriate. Freedom from death was calculated via Cox proportional hazards modeling; the relevance of individual predictors on mortality was determined by log-rank test.
RESULTS
The study enrolled 634 AAA patients; age 76.4 ± 8.0 years, aortic diameter 3.86 ± 0.7 cm. Participants were mostly male (88.8%), not current smokers (81.6%), and taking statins (76.7%). Mean follow-up was 2.1 ± 1.0 years. Estimated 1- and 3-year survival was 98.2% and 90.9%, respectively. Factors independently associated with mortality included larger aneurysm size (hazard ratio, 2.12; 95% confidence interval, 1.26-3.57 for diameter >4.0 cm) and diabetes (hazard ratio, 2.24; 95% confidence interval, 1.12-4.47). After adjusting for patient-level factors, health care system independently predicted mortality.
CONCLUSIONS
Contemporary all-cause mortality for patients with early AAA disease is lower than that previously reported. Further research is warranted to determine important factors that contribute to improved survival in early AAA disease.
目的
除了与动脉瘤相关的死亡风险增加之外，先前的研究还确定腹主动脉瘤（AAA）患者的全因死亡率过高，与冠心病相关的死亡率相当。然而，这些研究主要发生在前冠心病危险因素管理时代，并且没有最近的研究检查与早期 AAA 疾病（直径在 3 至 5 厘米之间的动脉瘤）相关的当代死亡率。作为对 AAA 进行的正在进行的自然史研究的一部分，我们报告了与早期疾病存在相关的死亡率风险。
方法
2006 年至 2011 年间，我们从北加利福尼亚的三个不同医疗保健系统中招募了参与者。在研究开始时收集了动脉瘤直径，人口统计学信息，合并症，药物治疗史和用于生物标志物分析的血浆。通过随访确定生存状态。适当的情况下，使用 t 检验或 χ 2 检验进行数据分析。通过 Cox 比例风险建模计算免于死亡的风险；通过对数秩检验确定单个预测因素对死亡率的相关性。
结果
该研究共纳入了 634 名 AAA 患者；年龄 76.4 ± 8.0 岁，主动脉直径 3.86 ± 0.7 cm。参与者主要为男性（88.8％），非当前吸烟者（81.6％）和服用他汀类药物（76.7％）。平均随访时间为 2.1 ± 1.0 年。估计的 1 年和 3 年生存率分别为 98.2％和 90.9％。与死亡率独立相关的因素包括更大的动脉瘤大小（危险比，2.12；95％置信区间，1.26-3.57，直径> 4.0 cm）和糖尿病（危险比，2.24；95％置信区间，1.12-4.47）。在调整了患者水平因素后，医疗保健系统独立地预测了死亡率。
结论
与先前报道相比，患有早期 AAA 疾病的患者的全因死亡率较低。需要进一步研究确定导致早期 AAA 疾病生存改善的重要因素。
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