腔内时代 B 型主动脉壁内血肿患者的生存和主动脉重塑结局：一项观察性队列研究。
Survival and aortic remodeling outcomes in patients with type B aortic intramural hematoma in the endovascular era: An observational cohort study.
机构信息
Vascular Surgery Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Vascular Surgery Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
J Vasc Surg. 2022 Jul;76(1):70-78. doi: 10.1016/j.jvs.2022.01.143. Epub 2022 Feb 25.
BACKGROUND
The late outcomes of patients with type B aortic intramural hematoma (IMH) receiving medical treatment (MT) have varied greatly. Whether endovascular stent graft placement in the descending aorta will provide beneficial effects for patients with type B IMH has remained uncertain. We have presented the survival and aortic remodeling outcomes for patients with type B IMH stratified by the treatment received (MT vs endovascular treatment [ET]).
METHODS
The participants were consecutively recruited from September 2010 to August 2017 from an institutional registry for type B IMH at Fuwai Hospital. The cohort was divided into two subgroups according to their treatment (MT vs ET). Kaplan-Meier estimations and propensity score-matched analysis were used to evaluate the outcomes after MT and ET.
RESULTS
The cohort included 347 patients with type B IMH (189 in the MT subgroup and 158 in the ET subgroup). During hospitalization, two patients (1.1%) in the MT subgroup and one patient (0.6%) in the ET subgroup had died. During follow-up (median, 3.4 years; interquartile range, 2.3-4.5 years; total patient-years, 1191.1), 36 patients had died of all causes. The cumulative probability of death was 0.03 per patient-year. The Kaplan-Meier estimated survival rates at 5 years were higher for the ET subgroup (94.9%) than for the MT subgroup (84.2%; P = .001). Cox regression analysis showed that ET was associated with a lower risk of death (hazard ratio, 0.32; 95% confidence interval, 0.15-0.69; P = .004). Follow-up computed tomography scans were completed for 244 patients. The incidence of IMH resolution in the ET subgroup (53.5%) was higher than that in the MT subgroup (33.3%; P = .003).
CONCLUSIONS
The present findings revealed different survival and aortic remodeling outcomes according to MT vs ET for consecutive patients with type B IMH. The survival rate was improved for the patients in the ET subgroup compared with that for the MT subgroup. Also, late progression to aortic dissection was less frequent in the ET subgroup.
背景
接受药物治疗（MT）的 B 型主动脉壁内血肿（IMH）患者的远期结局差异很大。在 B 型 IMH 患者中，在降主动脉内放置血管内支架移植物是否会带来有益效果仍不确定。我们根据所接受的治疗（MT 与血管内治疗[ET]），对 B 型 IMH 患者的生存和主动脉重塑结局进行了分层。
方法
参与者是 2010 年 9 月至 2017 年 8 月从阜外医院 B 型 IMH 机构登记处连续招募的。该队列根据治疗（MT 与 ET）分为两个亚组。Kaplan-Meier 估计和倾向评分匹配分析用于评估 MT 和 ET 后的结局。
结果
该队列包括 347 例 B 型 IMH 患者（MT 亚组 189 例，ET 亚组 158 例）。在住院期间，MT 亚组中有 2 例（1.1%）和 ET 亚组中有 1 例（0.6%）患者死亡。在随访期间（中位数 3.4 年；四分位距 2.3-4.5 年；总患者年 1191.1），36 例患者因各种原因死亡。患者的累积病死率为 0.03/患者年。ET 亚组的 5 年生存率（94.9%）高于 MT 亚组（84.2%；P=0.001）。Cox 回归分析显示，ET 与死亡风险降低相关（风险比 0.32；95%置信区间 0.15-0.69；P=0.004）。244 例患者完成了随访 CT 扫描。ET 亚组的 IMH 缓解率（53.5%）高于 MT 亚组（33.3%；P=0.003）。
结论
本研究发现，连续的 B 型 IMH 患者接受 MT 与 ET 的生存和主动脉重塑结局不同。与 MT 亚组相比，ET 亚组患者的生存率提高，且 ET 亚组晚期进展为主动脉夹层的发生率较低。
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