University Hospital Centre of São João, Porto, Portugal -
University Hospital Centre of São João, Porto, Portugal.
J Cardiovasc Surg (Torino). 2023 Feb;64(1):48-57. doi: 10.23736/S0021-9509.22.12210-X. Epub 2022 Sep 28.
Aortoiliac peripheral artery disease may lead to disabling lower limb claudication or to lower limb chronic threatening ischemia, which is associated with increased short and long-term morbi-mortality. The red blood cell distribution width-coefficient of variation (RDW-CV) has been able to predict outcomes in other atherosclerotic diseases, such as myocardial infarction and stroke. The main objective of this study was to assess the predictive ability of perioperative RDW-CV in accurately predicting short and long-term major adverse cardiovascular events (MACE) and all-cause mortality in patients submitted to aortoiliac revascularization due to extensive aortoiliac atherosclerotic disease.
From 2013 to 2020, patients who underwent aortoiliac revascularization due to severe aortoiliac disease were included in a prospective cohort. Blood samples were taken preoperatively and the patient's demographics, comorbidities, and postoperative outcomes were assessed. A multivariate Cox regression model was used to adjust for confounding and assess the independent effect of these prognostic factors on the outcomes.
The study group included 107 patients. Median follow-up was 57 (95% CI: 34.4-69.6) months. Preoperative RDW-CV was increased in thirty-eight patients (35.5%). Increased RDW-CV was associated with congestive heart failure - adjusted odds ratio of 5.043 (95% CI: 1.436-17.717, P=0.012). It could predict long-term occurrence of MACE (adjusted hazard ratio [aHR] 1.065, 95% CI: 1.014-1.118, P=0.011), all-cause mortality (aHR=1.069, 95% CI: 1.014-1.126, P=0.013), acute heart failure (AHF) (aHR=1.569, 95% CI: 1.179-2.088, P=0.002), and stroke (aHR=1.343, 95% CI: 1.044-1.727, P=0.022).
RDW is a widely available and low-cost marker that was able to independently predict long-term AHF, stroke, MACE, and all-cause mortality in patients with extensive aortoiliac disease submitted to revascularization. This biomarker could help assess which patients would likely benefit from stricter follow-up in the long-term.
主髂外周动脉疾病可导致下肢跛行或下肢慢性威胁性缺血，从而导致短期和长期病死率增加。红细胞分布宽度变异系数（RDW-CV）能够预测心肌梗死和中风等其他动脉粥样硬化疾病的预后。本研究的主要目的是评估围手术期 RDW-CV 预测因广泛主髂动脉粥样硬化疾病而行主髂血管重建术的患者短期和长期主要不良心血管事件（MACE）和全因死亡率的预测能力。
2013 年至 2020 年，因严重主髂动脉疾病而行主髂血管重建术的患者纳入前瞻性队列研究。术前采集血样，并评估患者的人口统计学、合并症和术后结果。采用多变量 Cox 回归模型进行调整，以评估这些预后因素对结果的独立影响。
研究组纳入 107 例患者。中位随访时间为 57 个月（95%可信区间：34.4-69.6）。38 例患者术前 RDW-CV 升高（35.5%）。RDW-CV 升高与充血性心力衰竭相关-校正优势比为 5.043（95%可信区间：1.436-17.717，P=0.012）。它可以预测长期发生 MACE（校正危害比[ aHR] 1.065，95%可信区间：1.014-1.118，P=0.011）、全因死亡率（aHR=1.069，95%可信区间：1.014-1.126，P=0.013）、急性心力衰竭（aHR=1.569，95%可信区间：1.179-2.088，P=0.002）和中风（aHR=1.343，95%可信区间：1.044-1.727，P=0.022）。
RDW 是一种广泛可用且成本低廉的标志物，可独立预测广泛主髂动脉疾病患者血管重建术后的长期急性心力衰竭、中风、MACE 和全因死亡率。该生物标志物可帮助评估哪些患者可能受益于长期更严格的随访。
