Zhu Hongqiao, Hu Bei, Zhang Heng, Li Haiyan, Zhou Jian, Jing Zaiping
Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University (Changhai Hospital), Shanghai, China.
Department of Vascular Surgery, The First Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
J Endovasc Ther. 2025 Feb;32(1):121-129. doi: 10.1177/15266028231168348. Epub 2023 May 9.
Lower serum ionized calcium (iCa) was reported to be associated with a higher risk of adverse events in patients with cardiovascular diseases. This study aimed to investigate the associations between preoperative serum iCa and outcomes of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR).
Between January 2016 and December 2019, 491 TBAD patients received TEVAR in a single center. Patients with acute or subacute TBAD were included. Serum iCa (pH 7.4) was obtained from the arterial blood gas analysis before TEVAR. The study population was grouped into the hi-Ca group (1.11 mmol/L ≤ iCa < 1.35 mmol/L) and lo-Ca group (iCa < 1.11 mmol/L). The primary outcomes were all-cause mortality. The secondary outcomes were any major adverse clinical events (MACEs), which included all-cause mortality and aortic-related severe complications. To eliminate bias, 1:1 propensity score matching (PSM) was conducted.
Overall, 396 TBAD patients were included in this study. In the total population, there were 119 (30.1%) patients in the lo-Ca group. After PSM, 77 matched pairs were obtained for further analysis. In the matched population, the 30-day mortality and 30-day MACEs between the two groups presented significant differences (p=0.023 and 0.029, respectively). At 5 years, cumulative incidences of mortality (log-rank p<0.001) and MACEs (log-rank p=0.016) were significantly higher in the lo-Ca group than that of the hi-Ca group. Multivariate cox regression analysis indicated that lower preoperative iCa (hazard ratio for per 0.1 mmol/L decrease, 2.191; 95% confidence interval, 1.487-3.228, p<0.001) was an independent risk factor for 5-year mortality after PSM.
Lower preoperative serum iCa might have an association with 5-year mortality in TBAD patients after TEVAR. Serum iCa monitoring in this population may facilitate the identification of critical conditions.
Our present study found that the cutoff value of preoperative serum iCa 1.11 mmol/L, which is slightly lower than the lower limit of the normal range of 1.15-1.35 mmol/L, worked relatively well for discerning the high-risk and low-risk TBAD patients at 5 years. Serum iCa monitoring in TBAD patients receiving TEVAR may facilitate the identification of critical conditions.
据报道，心血管疾病患者血清离子钙（iCa）降低与不良事件风险较高相关。本研究旨在探讨术前血清iCa与接受胸主动脉腔内修复术（TEVAR）的B型主动脉夹层（TBAD）患者预后之间的关联。
2016年1月至2019年12月期间，491例TBAD患者在单一中心接受了TEVAR。纳入急性或亚急性TBAD患者。在TEVAR前通过动脉血气分析获取血清iCa（pH 7.4）。研究人群分为高钙组（1.11 mmol/L≤iCa<1.35 mmol/L）和低钙组（iCa<1.11 mmol/L）。主要结局为全因死亡率。次要结局为任何主要不良临床事件（MACE），包括全因死亡率和主动脉相关严重并发症。为消除偏倚，进行了1:1倾向评分匹配（PSM）。
总体而言，本研究纳入了396例TBAD患者。在总人群中，低钙组有119例（30.1%）患者。PSM后，获得77对匹配病例用于进一步分析。在匹配人群中，两组之间的30天死亡率和30天MACE存在显著差异（分别为p = 0.023和0.029）。在5年时，低钙组的累积死亡率（对数秩检验p<0.001）和MACE累积发生率（对数秩检验p = 0.016）显著高于高钙组。多因素cox回归分析表明，术前iCa降低（每降低0.1 mmol/L的风险比为2.191；95%置信区间为1.487 - 3.228，p<0.001）是PSM后5年死亡率的独立危险因素。
术前血清iCa降低可能与TEVAR术后TBAD患者的5年死亡率相关。对该人群进行血清iCa监测可能有助于识别危急情况。
我们目前的研究发现，术前血清iCa的临界值1.11 mmol/L略低于正常范围下限1.15 - 1.35 mmol/L，在辨别5年时的高风险和低风险TBAD患者方面效果相对较好。对接受TEVAR的TBAD患者进行血清iCa监测可能有助于识别危急情况。
