Wrotniak Leszek, Kablak-Ziembicka Anna, Karch Izabela, Pieniazek Piotr, Rosławiecka Agnieszka, Mleczko Szymon, Tekieli Lukasz, Zmudka Krzysztof, Przewlocki Tadeusz
Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland
Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland.
J Ultrasound Med. 2016 Sep;35(9):1977-84. doi: 10.7863/ultra.15.10042. Epub 2016 Jul 27.
To identify independent predictors of cardiovascular events among patients with subclavian artery stenosis.
Two hundred eighteen consecutive patients with subclavian artery stenosis referred to angioplasty were examined for coexistent coronary, renal, or lower extremity artery stenosis of 50% or greater. Initial carotid intima-media thickness and internal carotid artery (ICA) stenosis were assessed. Intima-media thickness was reassessed in 108 randomly chosen patients to evaluate the change over time. The incidence of cardiovascular death, myocardial infarction (MI), ischemic stroke, and symptomatic lesion progression was recorded.
The patients included 116 men and 102 women (mean age ± SD, 62.1 ± 8.4 years). Isolated subclavian artery stenosis and involvement of 1, 2, and 3 or 4 other territories with stenosis of 50% or greater were found in 46 (21.1%), 83 (38.1%), 55 (25.2%), and 34 (15.6%) patients, respectively. Internal carotid artery stenosis of 50% or greater (relative risk [RR], 1.54; 95% confidence interval [CI], 1.39-1.70; P < .001) and initial intima-media thickness (RR, 1.16; 95% CI, 1.05-1.28; P = .005) were identified as independent markers of multiterritory atherosclerosis. The optimal intima-media thickness cutoff for atherosclerosis extent was 1.3 mm (sensitivity, 75.6%; specificity, 76.1%). During follow-up of 57 ± 35 months, cardiovascular death, MI, and ischemic stroke occurred in 29 patients (13.3%). Those patients had significantly higher intima-media thickness progression (+0.199 ± 0.57 versus +0.008 ± 0.26 mm; P = .039) and more widespread initial atherosclerosis (mean territories, 1.8 ± 1.1 versus 1.3 ± 1.1; P = .042). Independent predictors of cardiovascular death, MI, ischemic stroke, and lesion progression were coronary artery disease (RR, 1.32; 95% CI, 1.10-1.58; P = .003) and intima-media thickness progression (RR, 1.22; 95% CI, 1.02-1.46; P = .033; sensitivity, 75.0%; specificity, 61.8%).
In patients with symptomatic subclavian artery stenosis, baseline carotid intima-media thickness and ICA stenosis of 50% or greater are associated with multiterritory atherosclerosis, whereas intima-media thickness progression is associated with the risk of cardiovascular events.
确定锁骨下动脉狭窄患者心血管事件的独立预测因素。
对218例连续接受血管成形术的锁骨下动脉狭窄患者进行检查，以确定是否存在50%及以上的冠状动脉、肾动脉或下肢动脉狭窄。评估初始颈动脉内膜中层厚度和颈内动脉（ICA）狭窄情况。对108例随机选择的患者重新评估内膜中层厚度，以评估随时间的变化。记录心血管死亡、心肌梗死（MI）、缺血性中风和症状性病变进展的发生率。
患者包括116例男性和102例女性（平均年龄±标准差，62.1±8.4岁）。分别在46例（21.1%）、83例（38.1%）、55例（25.2%）和34例（15.6%）患者中发现孤立性锁骨下动脉狭窄以及累及1、2、3或4个其他区域且狭窄程度达50%及以上的情况。50%及以上的颈内动脉狭窄（相对风险[RR]，1.54；95%置信区间[CI]，1.39 - 1.70；P <.001）和初始内膜中层厚度（RR，1.16；95% CI，1.05 - 1.28；P =.005）被确定为多区域动脉粥样硬化的独立标志物。动脉粥样硬化程度的最佳内膜中层厚度临界值为1.3 mm（敏感性，75.6%；特异性，76.1%）。在57±35个月的随访期间，29例患者（13.3%）发生了心血管死亡、MI和缺血性中风。这些患者的内膜中层厚度进展明显更高（+0.199±0.57对+0.008±0.26 mm；P =.039），且初始动脉粥样硬化范围更广（平均区域数，1.8±1.1对1.3±1.1；P =.042）。心血管死亡、MI、缺血性中风和病变进展的独立预测因素是冠状动脉疾病（RR，1.32；95% CI，1.10 - 1.58；P =.003）和内膜中层厚度进展（RR，1.22；95% CI，1.02 - 1.46；P =.033；敏感性，75.0%；特异性，61.8%）。
在有症状的锁骨下动脉狭窄患者中，基线颈动脉内膜中层厚度和50%及以上的ICA狭窄与多区域动脉粥样硬化相关，而内膜中层厚度进展与心血管事件风险相关。
