Watanabe Masaki, Chaudhry Saqib A, Adil Malik Muhammad, Alqadri Syeda Laila, Majidi Shahram, Semaan Edouard, Qureshi Adnan I
Zeenat Qureshi Stroke Institute, St. Cloud, Minn.
Zeenat Qureshi Stroke Institute, St. Cloud, Minn.
J Vasc Surg. 2015 Apr;61(4):927-32. doi: 10.1016/j.jvs.2014.11.001.
Atrial fibrillation is a common comorbid condition among patients undergoing carotid endarterectomy (CEA) and carotid artery stent placement (CAS); however, the outcomes of patients with atrial fibrillation undergoing CAS have not been fully examined. We sought to investigate the impact of atrial fibrillation on outcomes of CEA and CAS in general practice.
We analyzed the data from the National Inpatient Sample (NIS), which is representative of all admissions in the United States from 2005 to 2009. The primary end point was postoperative stroke, cardiac complication, postoperative mortality, and composite of these end points. Univariate and multivariate regression analyses were performed to determine, first, the association of atrial fibrillation (compared to without atrial fibrillation) and, second, the association of CEA (compared with CAS) in patients with atrial fibrillation with the occurrence of postoperative stroke, cardiac complication, or death. Covariates included in the logistic regression were the patient's gender, age, race/ethnicity, comorbid conditions, and symptom status (symptomatic vs asymptomatic status) and the hospital's characteristics.
Of the total 672,074 patients who underwent CAS or CEA, 8.8% (95% confidence interval [CI], 8.7-8.9) of the procedures were performed in patients with atrial fibrillation. Atrial fibrillation was associated with an increased risk of postoperative stroke in patients undergoing CEA (n = 879 [1.7%]; P < .0001; odds ratio [OR], 1.57; 95% CI, 1.32-1.86) but not in patients undergoing CAS. The relative risk of the composite end point of postoperative stroke, cardiac complications, and mortality was increased in patients with atrial fibrillation undergoing CAS (OR, 1.43; 95% CI, 1.18-1.74) and in those undergoing CEA (OR, 3.18; 95% CI, 2.89-3.49). After adjustment for potential confounders, the odds of the composite end point of postoperative stroke, cardiac complications, and mortality (OR, 1.31; 95% CI, 1.08-1.59) in atrial fibrillation patients were significantly higher among patients who underwent CEA (compared with those who underwent CAS). An opposite relationship was seen in patients without atrial fibrillation, in whom the composite end point was significantly lower in patients undergoing CEA.
Our analysis suggests that almost 10% of CAS and CEA is performed in patients with atrial fibrillation in general practice, and higher rates of adverse events are observed among these patients, particularly those undergoing CEA.
心房颤动是接受颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）患者中常见的合并症；然而，心房颤动患者接受CAS的预后尚未得到充分研究。我们试图在一般实践中研究心房颤动对CEA和CAS预后的影响。
我们分析了来自国家住院患者样本（NIS）的数据，该样本代表了2005年至2009年美国所有住院患者。主要终点是术后中风、心脏并发症、术后死亡率以及这些终点的综合指标。进行单因素和多因素回归分析，首先确定心房颤动（与无心房颤动相比）的相关性，其次确定心房颤动患者中CEA（与CAS相比）与术后中风、心脏并发症或死亡发生的相关性。逻辑回归中纳入的协变量包括患者的性别、年龄、种族/民族、合并症、症状状态（有症状与无症状状态）以及医院的特征。
在总共672,074例接受CAS或CEA的患者中，8.8%（95%置信区间[CI]，8.7 - 8.9）的手术是在心房颤动患者中进行的。心房颤动与接受CEA患者术后中风风险增加相关（n = 879 [1.7%]；P <.0001；比值比[OR]，1.57；95% CI，1.32 - 1.86），但与接受CAS患者无关。接受CAS的心房颤动患者和接受CEA的心房颤动患者术后中风、心脏并发症和死亡率综合终点的相对风险均增加（接受CAS患者：OR，1.43；95% CI，1.18 - 1.74；接受CEA患者：OR，3.18；95% CI，2.89 - 3.49）。在调整潜在混杂因素后，接受CEA的心房颤动患者（与接受CAS的患者相比）术后中风、心脏并发症和死亡率综合终点的比值比（OR，1.31；95% CI，1.08 - 1.59）显著更高。在无心房颤动的患者中观察到相反的关系，即接受CEA的患者综合终点显著更低。
我们的分析表明，在一般实践中，近10%的CAS和CEA手术是在心房颤动患者中进行的，并且在这些患者中观察到更高的不良事件发生率，特别是那些接受CEA的患者。
