Division of Vascular and Endovascular Surgery, Department of Surgery University of California San Diego La Jolla CA USA.
Department of Surgery, Division of Vascular Surgery Loma Linda University Medical Center Loma Linda CA USA.
J Am Heart Assoc. 2023 Jul 18;12(14):e029761. doi: 10.1161/JAHA.122.029761. Epub 2023 Jul 14.
Background The best medical therapy to control hypertension following abdominal aortic aneurysm repair is yet to be determined. We therefore examined whether treatment with renin-angiotensin-aldosterone system inhibitors (RAASIs) versus beta blockers influenced postoperative and 1-year clinical end points following abdominal aortic aneurysm repair in a Medicare-linked database. Methods and Results All patients with hypertension undergoing endovascular aneurysm repair and open aneurysm repair in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database between 2003 and 2018 were included. Patients were divided into 2 groups based on their preoperative and discharge medications, either RAASIs or beta blockers. Our cohort included 8789 patients, of whom 3523 (40.1%) were on RAASIs, and 5266 (59.9%) were on beta blockers. After propensity score matching, there were 3053 matched pairs of patients in each group. After matching, RAASI use was associated with lower risk of postoperative mortality (odds ratio [OR], 0.3 [95% CI, 0.1-0.6]), myocardial infarction (OR, 0.1 [95% CI, 0.03-0.6]), and nonhome discharge (OR, 0.6 [95% CI, 0.5-0.7]). Before propensity score matching, RAASI use was associated with lower 1-year mortality (hazard ratio [HR], 0.4 [95% CI, 0.4-0.5]) and lower risk of aneurysmal rupture (HR, 0.7 [95% CI, 0.5-0.9]). These results persisted after propensity score matching for mortality (HR, 0.4 [95% CI, 0.4-0.5]) and aneurysmal rupture (HR, 0.7 [95% CI, 0.5-0.9]). Conclusions In this large contemporary retrospective cohort study, RAASI use was associated with favorable postoperative outcomes compared with beta blockers. It was also associated with lower mortality and aneurysmal rupture at 1 year of follow-up.
控制腹主动脉瘤修复术后高血压的最佳医学疗法仍有待确定。因此，我们在医疗保险相关数据库中检查了肾素-血管紧张素-醛固酮系统抑制剂（RAASIs）与β受体阻滞剂治疗对腹主动脉瘤修复术后和 1 年临床终点的影响。
纳入 2003 年至 2018 年间血管质量倡议血管植入监测和干预结果网络数据库中接受血管内动脉瘤修复和开放动脉瘤修复的高血压患者。根据术前和出院时的药物将患者分为 RAASIs 或β受体阻滞剂两组。我们的队列包括 8789 例患者，其中 3523 例（40.1%）服用 RAASIs，5266 例（59.9%）服用β受体阻滞剂。经倾向评分匹配后，每组各有 3053 对匹配患者。匹配后，RAASI 使用率与术后死亡率（比值比[OR]，0.3 [95%CI，0.1-0.6]）、心肌梗死（OR，0.1 [95%CI，0.03-0.6]）和非家庭出院（OR，0.6 [95%CI，0.5-0.7]）的风险降低相关。在倾向评分匹配之前，RAASI 使用率与 1 年死亡率（风险比[HR]，0.4 [95%CI，0.4-0.5]）和动脉瘤破裂风险降低相关（HR，0.7 [95%CI，0.5-0.9]）。这些结果在匹配死亡率（HR，0.4 [95%CI，0.4-0.5]）和动脉瘤破裂（HR，0.7 [95%CI，0.5-0.9]）后仍然存在。
在这项大型当代回顾性队列研究中，与β受体阻滞剂相比，RAASI 使用率与术后良好结局相关。它还与 1 年随访时的死亡率和动脉瘤破裂风险降低相关。
