Division of Vascular and Endovascular Surgery University of California San Diego La Jolla CA.
Department of Surgery State University New York Downstate University Health Sciences University Brooklyn NY.
J Am Heart Assoc. 2022 Sep 6;11(17):e025034. doi: 10.1161/JAHA.121.025034. Epub 2022 Aug 24.
Background Previous data suggest that using renin-angiotensin-aldosterone system inhibitors (RAASIs) improves survival in patients with cardiovascular diseases. We sought to investigate the association of different patterns of use of RAASIs on perioperative and 1-year outcomes following carotid revascularization. Methods and Results We investigated patients undergoing carotid revascularization, either with carotid endarterectomy or transfemoral carotid artery stenting, in the VQI (Vascular Quality Initiative) VISION (Vascular Implant Surveillance and Interventional Outcomes Network) data set between 2003 and 2018. We divided our cohort into 3 groups: (1) no history of RAASI intake, (2) preoperative intake only, and (3) continuous pre- and postoperative intake. The final cohort included 73 174 patients; 44.4% had no intake, 50% had continuous intake, and 5.6% had only preoperative intake. Compared with continuous intake, preoperative and no intake were associated with higher odds of postoperative stroke (odds ratio [OR], 1.7 [95% CI, 1.5-1.9]; <0.001; OR, 1.1 [95% CI, 1.03-1.2]; =0.010); death (OR, 4.8 [95% CI, 3.8-6.1]; <0.001; OR, 1.9 [95% CI, 1.6-2.2]; <0.001); and stroke/death (OR, 2.05 [95% CI, 1.8-2.3]; <0.001; OR, 1.2 [95% CI, 1.1-1.3]; <0.001), respectively. At 1 year, preoperative and no intake were associated with higher odds of stroke (hazard ratio [HR], 1.4 [95% CI, 1.3-1.6]; <0.001; HR, 1.15, [95% CI, 1.08-1.2]; <0.001); death (HR, 1.7 [95% CI, 1.5-1.9]; <0.001; HR, 1.3 [95% CI, 1.2-1.4]; <0.001); and stroke/death (HR, 1.5 [95% CI, 1.4-1.7]; <0.001; HR, 1.2 [95% CI, 1.17-1.3]; <0.001), respectively. Conclusions Compared with subjects discontinuing or never starting RAASIs, use of RAASIs before and after carotid revascularization was associated with a short-term stroke and mortality benefit. Future clinical trials examining prescribing patterns of RAASIs should aim to clarify the timing and potential to maximize the protective effects of RAASIs in high-risk vascular patients.
先前的数据表明，使用肾素-血管紧张素-醛固酮系统抑制剂（RAASIs）可改善心血管疾病患者的生存。我们旨在研究不同模式的 RAASI 使用与颈动脉血运重建术后围手术期和 1 年结局之间的关系。
我们研究了 2003 年至 2018 年间 VQI（血管质量倡议） VISION（血管植入监测和介入结果网络）数据集中接受颈动脉血运重建（颈动脉内膜切除术或经股动脉颈动脉支架置入术）的患者。我们将队列分为 3 组：（1）无 RAASI 摄入史，（2）术前仅摄入，（3）术前和术后持续摄入。最终队列包括 73174 例患者；44.4%没有摄入，50%持续摄入，5.6%仅术前摄入。与持续摄入相比，术前和无摄入与术后卒中的几率更高相关（比值比[OR]，1.7[95%置信区间，1.5-1.9]；<0.001；OR，1.1[95%置信区间，1.03-1.2]；=0.010）；死亡（比值比[OR]，4.8[95%置信区间，3.8-6.1]；<0.001；OR，1.9[95%置信区间，1.6-2.2]；<0.001）；和卒中/死亡（比值比[OR]，2.05[95%置信区间，1.8-2.3]；<0.001；OR，1.2[95%置信区间，1.1-1.3]；<0.001）。在 1 年时，术前和无摄入与卒中的几率更高相关（风险比[HR]，1.4[95%置信区间，1.3-1.6]；<0.001；HR，1.15，[95%置信区间，1.08-1.2]；<0.001）；死亡（风险比[HR]，1.7[95%置信区间，1.5-1.9]；<0.001；HR，1.3[95%置信区间，1.2-1.4]；<0.001）；和卒中/死亡（风险比[HR]，1.5[95%置信区间，1.4-1.7]；<0.001；HR，1.2[95%置信区间，1.17-1.3]；<0.001）。
与停止或从未开始使用 RAASIs 的受试者相比，颈动脉血运重建前后使用 RAASIs 与短期卒中发生率和死亡率降低相关。未来研究 RAASIs 处方模式的临床试验应旨在阐明时间和潜力，以最大限度地提高高危血管患者的 RAASI 保护作用。
