Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, Calif.
Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
J Vasc Surg. 2020 Nov;72(5):1711-1719.e2. doi: 10.1016/j.jvs.2020.01.065. Epub 2020 Apr 2.
Anemia has been identified as a risk factor for postoperative morbidity and mortality after major vascular procedures. Carotid revascularization carries less cardiac morbidity and physiologic stress compared with other vascular interventions. This study evaluated the association between preoperative anemia and major adverse events after carotid revascularization.
Patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS) between January 2012 and June 2018 in the Vascular Quality Initiative database were identified. Anemia was defined as a preoperative hemoglobin level of <12 g/dL in women and <13 g/dL in men. Multivariable logistic analysis and 1:1 coarsened exact matching were used to study the association between preoperative anemia and in-hospital major adverse cardiac events (MACEs), defined as a composite of stroke, death, and myocardial infarction, and between anemia and 30-day mortality after CEA and CAS.
Of 102,719 patients included in the analysis, 34.8% were anemic (CEA, 34.1%; CAS, 37.8%; P < .001). Anemic patients were older and had more medical comorbidities compared with nonanemic patients. In-hospital MACEs (2.8% vs 1.9%; P < .001) and 30-day mortality (0.9% vs 0.4%; P < .001) were higher among anemic patients. On multivariable analysis, anemia was associated with 18% higher odds of in-hospital MACEs (odds ratio, 1.18; 95% confidence interval, 1.07-1.31, P = .001) and 74% higher odds of 30-day mortality (odds ratio, 1.74; 95% confidence interval, 1.40-2.17, P < .001). Coarsened exact matching showed similar results. The association between preoperative anemia and adverse outcomes was similar in both CAS and CEA and in symptomatic and asymptomatic patients (P interaction > .05).
Anemia is associated with increased odds of adverse events after CEA and CAS. It should be factored into the preoperative risk assessment of patients undergoing carotid revascularization. Prospective studies are needed to study the effectiveness of correcting low preoperative hemoglobin levels in these patients and the association between anemia and long-term outcomes after CEA and CAS.
贫血已被确定为大血管手术后发病率和死亡率的一个风险因素。与其他血管介入相比，颈动脉血运重建术的心脏发病率和生理应激较低。本研究评估了术前贫血与颈动脉血运重建术后主要不良事件之间的关系。
从血管质量倡议数据库中确定了 2012 年 1 月至 2018 年 6 月期间接受颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）的患者。术前贫血定义为女性血红蛋白水平<12g/dL，男性<13g/dL。多变量逻辑分析和 1:1 粗化精确匹配用于研究术前贫血与住院期间主要不良心脏事件（MACEs）之间的关系，MACEs 定义为中风、死亡和心肌梗死的综合指标，以及 CEA 和 CAS 后 30 天死亡率之间的关系。
在纳入分析的 102719 名患者中，34.8%为贫血患者（CEA：34.1%；CAS：37.8%；P<0.001）。与非贫血患者相比，贫血患者年龄更大，且有更多的合并症。住院期间的 MACEs（2.8%比 1.9%；P<0.001）和 30 天死亡率（0.9%比 0.4%；P<0.001）更高。多变量分析显示，贫血与住院期间 MACEs 发生的风险增加 18%相关（比值比，1.18；95%置信区间，1.07-1.31，P=0.001），30 天死亡率增加 74%相关（比值比，1.74；95%置信区间，1.40-2.17，P<0.001）。粗化精确匹配显示出类似的结果。术前贫血与不良结局之间的关联在 CAS 和 CEA 以及症状性和无症状性患者中相似（P 交互>0.05）。
贫血与 CEA 和 CAS 后不良事件的发生风险增加相关。在对接受颈动脉血运重建的患者进行术前风险评估时，应考虑到这一点。需要前瞻性研究来研究纠正这些患者术前低血红蛋白水平的效果，以及贫血与 CEA 和 CAS 后长期结局之间的关系。
