Tsai Ming-Lung, Mao Chun-Tai, Chen Dong-Yi, Hsieh I-Chang, Wen Ming-Shien, Chen Tien-Hsing
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
PLoS One. 2015 Mar 24;10(3):e0121016. doi: 10.1371/journal.pone.0121016. eCollection 2015.
Carotid artery stenosis is one of the leading causes of ischemic stroke. Carotid artery stenting has become well-established as an effective treatment option for carotid artery stenosis. For this study, we aimed to determine the efficacy and safety of carotid stenting in a population-based large cohort of patients by analyzing the Taiwan National Healthcare Insurance (NHI) database.
2,849 patients who received carotid artery stents in the NHI database from 2004 to 2010 were identified. We analyzed the risk factors of outcomes including major adverse cardiovascular events including death, acute myocardial infarction, and cerebral vascular accidents at 30 days, 1 year, and overall period and further evaluated cause of death after carotid artery stenting.
The periprocedural stroke rate was 2.7% and the recurrent stroke rate for the overall follow-up period was 20.3%. Male, diabetes mellitus, and heart failure were significant risk factors for overall recurrent stroke (Hazard Ratio (HR) = 1.35, p = 0.006; HR = 1.23, p = 0.014; HR = 1.61, p < 0.001, respectively). The periprocedural acute myocardial infarction rate was 0.3%. Age and Diabetes mellitus were the significant factors to predict periprocedural myocardial infarction (HR = 3.06, p = 0.019; HR = 1.68, p < 0.001, respectively). Periprocedural and overall mortality rates were 1.9% and 17.3%, respectively. The most significant periprocedural mortality risk factor was acute renal failure. Age, diabetes mellitus, acute or chronic renal failure, heart failure, liver disease, and malignancy were factors correlated to the overall period mortality.
Periprocedural acute renal failure significantly increased the mortality rate and the number of major adverse cardiovascular events, and the predict power persisted more than one year after the procedure. Age and diabetes mellitus were significant risk factors to predict acute myocardial infarction after carotid artery stenting.
颈动脉狭窄是缺血性中风的主要病因之一。颈动脉支架置入术已成为治疗颈动脉狭窄的一种行之有效的方法。在本研究中，我们旨在通过分析台湾国民健康保险（NHI）数据库，确定基于人群的大型队列患者中颈动脉支架置入术的疗效和安全性。
在NHI数据库中识别出2004年至2010年期间接受颈动脉支架置入术的2849例患者。我们分析了包括30天、1年及整个随访期内的主要不良心血管事件（包括死亡、急性心肌梗死和脑血管意外）等结局的危险因素，并进一步评估了颈动脉支架置入术后的死亡原因。
围手术期卒中发生率为2.7%，整个随访期内复发性卒中发生率为20.3%。男性、糖尿病和心力衰竭是总体复发性卒中的显著危险因素（风险比（HR）分别为1.35，p = 0.006；HR = 1.23，p = 0.014；HR = 1.61，p < 0.001）。围手术期急性心肌梗死发生率为0.3%。年龄和糖尿病是预测围手术期心肌梗死的重要因素（HR分别为3.06，p = 0.019；HR = 1.68，p < 0.001）。围手术期和总体死亡率分别为1.9%和17.3%。围手术期最显著的死亡危险因素是急性肾衰竭。年龄、糖尿病、急性或慢性肾衰竭、心力衰竭、肝病和恶性肿瘤是与整个随访期死亡率相关的因素。
围手术期急性肾衰竭显著增加死亡率和主要不良心血管事件的发生数量，且该预测作用在术后一年多仍持续存在。年龄和糖尿病是预测颈动脉支架置入术后急性心肌梗死的重要危险因素。
