Li Wei, Luo Songyuan, Lin Wenhui, Su Sheng, Xu Wenmin, Hu Xiaolu, Liu Yuan, Huang Wenhui, Luo Jianfang, Zhou Yingling
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Cardiovasc Med. 2022 Dec 14;9:1041706. doi: 10.3389/fcvm.2022.1041706. eCollection 2022.
Previous studies reported a high prevalence of concomitant coronary artery disease (CAD) in patients with Type B aortic dissection (TBAD). However, there is too limited data on the impact of CAD on prognosis in patients with TBAD. The present study aimed to assess the short-term and long-term impact of CAD on patients with acute or subacute TBAD undergoing thoracic endovascular aortic repair (TEVAR).
We retrospectively evaluated 463 patients with acute or subacute TBAD undergoing TEVAR from a prospectively maintained database from 2010 to 2017. CAD was defined before TEVAR by coronary angiography. Multivariable logistic and cox regression analyses were performed to evaluate the relationship between CAD and the short-term as well as long-term outcomes.
According to the results of coronary angiography, the 463 patients were divided into the following two groups: CAD group ( = 148), non-CAD group ( = 315). In total, 12 (2.6%) in-hospital deaths and 54 (12%) all-cause deaths following a median follow-up of 48.1 months were recorded. Multivariable analysis revealed that CAD was an independent predictor of in-hospital major adverse clinical events (MACE) (odd ratio [OR], 2.33; 95% confidence interval [CI], 1.07-5.08; = 0.033), long-term mortality [hazard ratio (HR), 2.11, 95% CI, 1.19-3.74, = 0.011] and long-term MACE (HR, 1.95, 95% CI, 1.26-3.02, = 0.003). To further clarify the relationship between the severity of CAD and long-term outcomes, we categorized patients into three groups: zero-vessel disease, single-vessel disease and multi-vessel disease. The long-term mortality (9.7 vs. 14.4 vs. 21.2%, = 0.045), and long-term MACE (16.8 vs. 22.2 vs. 40.4%, = 0.001) increased with the number of identified stenosed coronary vessels. Multivariable analysis indicated that, multi-vessel disease was independently associated with long-term mortality (HR, 2.38, 95% CI, 1.16-4.89, = 0.018) and long-term MACE (HR, 2.79, 95% CI, 1.65-4.73, = 0.001), compared with zero-vessel disease.
CAD was associated with short-term and long-term worse outcomes in patients with acute or subacute TBAD undergoing TEVAR. Furthermore, the severity of CAD was also associated with worse long-term prognosis. Therefore, CAD could be considered as a useful independent predictor for pre-TEVAR risk stratification in patients with TBAD.
既往研究报道，B型主动脉夹层（TBAD）患者中冠状动脉疾病（CAD）的合并患病率较高。然而，关于CAD对TBAD患者预后影响的数据非常有限。本研究旨在评估CAD对接受胸主动脉腔内修复术（TEVAR）的急性或亚急性TBAD患者的短期和长期影响。
我们对2010年至2017年前瞻性维护数据库中463例接受TEVAR的急性或亚急性TBAD患者进行了回顾性评估。CAD在TEVAR术前通过冠状动脉造影进行定义。进行多变量逻辑回归和Cox回归分析，以评估CAD与短期和长期结局之间的关系。
根据冠状动脉造影结果，463例患者分为以下两组：CAD组（n = 148），非CAD组（n = 315）。共记录到12例（2.6%）住院死亡和54例（12%）全因死亡，中位随访时间为48.1个月。多变量分析显示，CAD是住院期间主要不良临床事件（MACE）的独立预测因素（比值比[OR]，2.33；95%置信区间[CI]，1.07 - 5.08；P = 0.033）、长期死亡率[风险比（HR），2.11，95% CI，1.19 - 3.74，P = 0.011]和长期MACE（HR，1.95，95% CI，1.26 - 3.02，P = 0.003）。为进一步阐明CAD严重程度与长期结局之间的关系，我们将患者分为三组：零支血管病变、单支血管病变和多支血管病变。长期死亡率（9.7%对14.4%对21.2%，P = 0.045）和长期MACE（16.8%对22.2%对40.4%，P = 0.001）随狭窄冠状动脉血管数量的增加而升高。多变量分析表明，与零支血管病变相比，多支血管病变与长期死亡率（HR，2.38，95% CI，1.16 - 4.89，P = 0.018）和长期MACE（HR，2.79，95% CI，1.65 - 4.73，P = 0.001）独立相关。
CAD与接受TEVAR的急性或亚急性TBAD患者的短期和长期不良结局相关。此外CAD的严重程度也与较差的长期预后相关。因此，CAD可被视为TBAD患者TEVAR术前风险分层的有用独立预测因素。
