Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.
Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.
Semin Thromb Hemost. 2022 Jun;48(4):465-480. doi: 10.1055/s-0042-1748152. Epub 2022 Jun 30.
There is an increased risk of arterial events including major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after venous thromboembolism (VTE). However, their risk factors remain little explored.
We aimed to determine the risk factors for MACE (acute coronary syndrome/stroke/cardiovascular death) and MALE (limb ischemia/critical limb ischemia/non-traumatic amputation/any limb revascularization) after VTE. Competing risk models (Fine-Gray) were used in a multicenter prospective cohort of 4,940 patients (mean age: 64.6 years and median follow-up: 64 months).
MACE occurred in 17.3% of participants (2.35% per patient-years) and MALE in 1.7% (0.27% per patient-years). In multivariable analysis, the identified risk factors for MACE were the age of 50 to 65 years (vs. <50 years, hazard ratio [HR]: 2.00, 95% confidence interval [CI]: 1.38-2.91), age >65 years (vs. <50 years, HR 4.85, 95% CI: 3.35-7.02), pulmonary embolism + deep vein thrombosis (DVT) (vs. isolated-DVT, HR: 1.25, 95% CI: 1.02-1.55), unprovoked-VTE (vs. transient risk factor associated-VTE, HR: 1.29, 95% CI: 1.04-1.59), current tobacco use (vs. never, HR: 1.45, 95% CI: 1.07-1.98), hypertension (HR: 1.61, 95% CI: 1.30-1.98), past history of symptomatic atherosclerosis (HR: 1.52, 95% CI: 1.17-1.98), heart failure (HR: 1.71, 95% CI: 1.21-2.42), atrial fibrillation (HR: 1.55, 95% CI: 1.15-2.08), and vena cava filter insertion (HR: 1.46, 95% CI: 1.03-2.08). The identified risk factors for MALE were the age of 50-65 years (vs. <50 years, HR: 3.49, 95% CI: 1.26-9.65) and atrial fibrillation (HR: 2.37, 95% CI: 1.15-4.89).
Risk factors for MACE and MALE after VTE included some traditional cardiovascular risk factors, patient's comorbidities, and some characteristics of VTE.
静脉血栓栓塞症（VTE）后，动脉事件（包括主要不良心血管事件[MACE]和主要不良肢体事件[MALE]）的风险增加。然而，其风险因素仍未得到充分探讨。
我们旨在确定 VTE 后 MACE（急性冠脉综合征/中风/心血管死亡）和 MALE（肢体缺血/临界肢体缺血/非创伤性截肢/任何肢体血运重建）的风险因素。多中心前瞻性队列的 4940 名患者（平均年龄：64.6 岁，中位随访时间：64 个月）使用竞争风险模型（Fine-Gray）。
17.3%的参与者发生 MACE（每患者年 2.35%），1.7%发生 MALE（每患者年 0.27%）。多变量分析显示，MACE 的风险因素包括 50-65 岁年龄组（<50 岁，风险比[HR]：2.00，95%置信区间[CI]：1.38-2.91），>65 岁年龄组（<50 岁，HR：4.85，95% CI：3.35-7.02），肺栓塞+深静脉血栓形成（DVT）（孤立 DVT，HR：1.25，95% CI：1.02-1.55），无诱因 VTE（与短暂性相关风险因素 VTE，HR：1.29，95% CI：1.04-1.59），当前吸烟（从不，HR：1.45，95% CI：1.07-1.98），高血压（HR：1.61，95% CI：1.30-1.98），既往有症状性动脉粥样硬化病史（HR：1.52，95% CI：1.17-1.98），心力衰竭（HR：1.71，95% CI：1.21-2.42），心房颤动（HR：1.55，95% CI：1.15-2.08），腔静脉滤器置入（HR：1.46，95% CI：1.03-2.08）。MALE 的风险因素包括 50-65 岁年龄组（<50 岁，HR：3.49，95% CI：1.26-9.65）和心房颤动（HR：2.37，95% CI：1.15-4.89）。
VTE 后 MACE 和 MALE 的风险因素包括一些传统心血管风险因素、患者合并症和 VTE 的一些特征。
