Nakazawa Kenneth R, Wengerter Sean P, Power John R, Lookstein Robert A, Tadros Rami O, Ting Windsor, Faries Peter L, Vouyouka Ageliki G
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
J Vasc Surg. 2017 Jul;66(1):151-159. doi: 10.1016/j.jvs.2017.01.031. Epub 2017 Mar 1.
The purpose of this study was to evaluate the impact of preoperative inflammatory status, as determined by complete blood count test parameters, on 12- and 24-month patency of femoropopliteal stenting for peripheral arterial disease.
We retrospectively analyzed baseline clinical and angiographic data among 138 patients (median age, 73 years; 46% female) from 2005 to 2014 at our institution with preoperative complete blood count test values and information of patency for at least 12 months after first-time femoropopliteal stenting. Patients were stratified into tertiles on the basis of preoperative blood counts to evaluate associations with in-stent restenosis (ISR) leading to loss of primary patency, defined by a Doppler velocity ratio ≥2.5:1, computed tomography angiography demonstrating ≥50% luminal narrowing within the stent, or reintervention.
Univariate analysis determined that the 81 patients (59%) who experienced ISR within 12 months had significantly higher preoperative white blood cell (WBC), platelet, neutrophil, and lymphocyte counts than the 57 patients (41%) whose stents remained patent for longer than 12 months (8.7 vs 6.7 [P < .001], 246 vs 184 [P < .001], 5.7 vs 4.7 [P = .001], and 1.8 vs 1.2 [P = .004], respectively). Compared with patients in the lower WBC tertile (n = 45) who had a median patency of 19.4 months, those in the upper WBC tertile (n = 44) had a median patency of only 7.0 months and a 3.3-fold increased risk for ISR after adjusting for age, sex, lesion type, TransAtlantic Inter-Society Consensus II score, tibial vessel runoff, antiplatelet therapy, presence of diabetes, critical limb ischemia, adjunct procedures, hyperlipidemia, and end-stage renal disease in multivariate analysis (P < .001). Compared with patients in the lower platelet tertile (n = 45) who had a median patency of 16.9 months, those in the upper platelet tertile (n = 47) had a median patency of 7.1 months and a 2.7-fold increased adjusted risk (P = .001). Compared with patients in the lower neutrophil tertile (n = 33) who had a median patency of 14.3 months, those in the upper neutrophil tertile (n = 33) had a median patency of 6.2 months and a 3.2-fold increased adjusted risk (P = .001). After adjusting for covariates, patients divided into tertiles by lymphocyte counts exhibited no significant differences for ISR.
Routine preoperative tests that determine baseline inflammatory status may provide strong clinical utility in assessing potential risk stratification of patients for ISR after femoropopliteal stenting. Circulating WBCs, platelets, and neutrophils may be important inflammatory mediators of ISR.
本研究旨在评估通过全血细胞计数测试参数确定的术前炎症状态对股腘动脉支架置入术治疗外周动脉疾病12个月和24个月通畅率的影响。
我们回顾性分析了2005年至2014年在我院接受首次股腘动脉支架置入术且有术前全血细胞计数测试值及至少12个月通畅信息的138例患者（中位年龄73岁；46%为女性）的基线临床和血管造影数据。根据术前血细胞计数将患者分为三分位数，以评估与导致原发性通畅丧失的支架内再狭窄（ISR）的相关性，原发性通畅丧失定义为多普勒速度比≥2.5:1、计算机断层血管造影显示支架内管腔狭窄≥50%或再次干预。
单因素分析确定，12个月内发生ISR的81例患者（59%）术前白细胞（WBC）、血小板、中性粒细胞和淋巴细胞计数显著高于支架通畅时间超过12个月的57例患者（41%）（分别为8.7对6.7[P <.001]、246对184[P <.001]、5.7对4.7[P =.001]和1.8对1.2[P =.004]）。与WBC三分位数较低的患者（n = 45，中位通畅时间为19.4个月）相比，WBC三分位数较高的患者（n = 44）中位通畅时间仅为7.0个月，在多因素分析中，调整年龄、性别、病变类型、跨大西洋两岸社会共识II评分、胫血管流出、抗血小板治疗、糖尿病、严重肢体缺血、辅助手术、高脂血症和终末期肾病后，ISR风险增加3.3倍（P <.001）。与血小板三分位数较低的患者（n = 45，中位通畅时间为16.9个月）相比，血小板三分位数较高的患者（n = 47）中位通畅时间为7.1个月，调整后风险增加2.7倍（P =.001）。与中性粒细胞三分位数较低的患者（n = 33，中位通畅时间为14.3个月）相比，中性粒细胞三分位数较高的患者（n = 33）中位通畅时间为6.2个月，调整后风险增加3.2倍（P =.001）。调整协变量后，按淋巴细胞计数分为三分位数的患者在ISR方面无显著差异。
确定基线炎症状态的常规术前检查在评估股腘动脉支架置入术后患者ISR的潜在风险分层方面可能具有强大的临床实用性。循环中的白细胞、血小板和中性粒细胞可能是ISR的重要炎症介质。
