Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia.
Eur J Vasc Endovasc Surg. 2021 Dec;62(6):960-968. doi: 10.1016/j.ejvs.2021.09.011. Epub 2021 Nov 2.
The aim of this study was to examine whether there were independent associations between abdominal aortic diameter, size index, and height index and the risk of major adverse events in patients referred for treatment of various types of aortic and peripheral occlusive and aneurysmal disease (APOAD).
In total, 1 752 participants with a variety of APOADs were prospectively recruited between 2002 and 2020 and had a maximum abdominal aortic diameter, aortic size index (aortic diameter relative to body surface area), and aortic height index (aortic diameter relative to height) measured by ultrasound at recruitment. Participants were followed for a median of 4.6 years (interquartile range 2.0 - 8.0 years) to record outcome events, including major adverse cardiovascular events (MACE), peripheral artery surgery, abdominal aortic aneurysm (AAA) events (rupture or repair), and all cause mortality. The association between aortic size and events was assessed using Cox proportional hazard analysis. The ability of aortic size to improve risk of events classification was assessed using the net reclassification index (NRI).
After adjusting for other risk factors, larger aortic diameter was associated with an increased risk of MACE (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05 - 1.31), requirement for peripheral artery surgery (HR 2.05, 95% CI 1.90 - 2.22), AAA events (HR 3.01, 95% CI 2.77 - 3.26), and all cause mortality (HR 1.20, 95% CI 1.08 - 1.32). Findings were similar for aortic size and aortic height indices. According to the NRI, all three aortic size measures significantly improved classification of risk of peripheral artery surgery and AAA events but not MACE. Aortic size index, but not aortic diameter or aortic height index, significantly improved the classification of all cause mortality risk.
Larger abdominal aortic diameter, size index, and height index are all independently associated with an increased risk of major adverse events in patients with established vascular disease.
本研究旨在探讨腹主动脉直径、大小指数和高度指数与各种类型的主动脉和外周闭塞性及动脉瘤性疾病（APOAD）患者的主要不良事件风险之间是否存在独立关联。
本研究共前瞻性招募了 2002 年至 2020 年期间患有多种 APOAD 的 1752 名患者，在招募时通过超声测量最大腹主动脉直径、主动脉大小指数（主动脉直径与体表面积的比值）和主动脉高度指数（主动脉直径与身高的比值）。中位随访时间为 4.6 年（四分位距 2.0-8.0 年），以记录主要不良心血管事件（MACE）、外周动脉手术、腹主动脉瘤（AAA）事件（破裂或修复）和全因死亡率等结局事件。使用 Cox 比例风险分析评估主动脉大小与事件之间的关联。使用净重新分类指数（NRI）评估主动脉大小改善事件分类的能力。
在校正其他危险因素后，较大的主动脉直径与 MACE 风险增加相关（风险比 [HR] 1.17，95%置信区间 [CI] 1.05-1.31）、外周动脉手术的需求（HR 2.05，95% CI 1.90-2.22）、AAA 事件（HR 3.01，95% CI 2.77-3.26）和全因死亡率（HR 1.20，95% CI 1.08-1.32）。主动脉大小和主动脉高度指数的结果相似。根据 NRI，所有三种主动脉大小测量均显著改善了外周动脉手术和 AAA 事件风险的分类，但对 MACE 无显著改善。主动脉大小指数，但不是主动脉直径或主动脉高度指数，显著改善了全因死亡率风险的分类。
较大的腹主动脉直径、大小指数和高度指数均与已确诊血管疾病患者的主要不良事件风险增加独立相关。
