Vicario-Feliciano Raquel, Zil-E-Ali Ahsan, Aziz Faisal
Division of Vascular Surgery, Heart and Vascular Institute, Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA.
Division of Vascular Surgery, Heart and Vascular Institute, Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA.
Ann Vasc Surg. 2025 Jan;110(Pt B):395-404. doi: 10.1016/j.avsg.2024.07.104. Epub 2024 Aug 3.
Predictors of sac behavior after endovascular aortic aneurysm repair (EVAR) and the impact of sac behavior on long-term survival are not well known. There are limited multicenter trials studying the impact of beta blockers (BBs) on sac behavior. BBs have consistently failed to show a benefit on abdominal aortic aneurysm sac regression in patients with connective tissue disorders and the general population. This study aims to assess the association between BBs and sac behavior after EVAR.
Patients undergoing EVAR registered in Vascular Quality Initiative (2003-2021) stratified by BB and no BB on discharged after an index procedure were assessed at follow-up of 30 days and 1 year. The primary outcomes included mortality and reintervention at 30 days and 1 year. The causes of reintervention were also studied at the defined time endpoints. Categorical and continuous variables were analyzed separately for association between the 2 groups. A P value of <0.05 was considered statistically significant.
A total of 50,411 patients, stratified by BB (28,866; 57.3%), and no BB (21,545; 42.7%) were studied. Patients with hypertension, diabetes, chronic obstructive pulmonary disease, coronary artery disease, prior history of coronary artery bypass graft or percutaneous coronary intervention, prior angioplasty or stent, lower extremity bypass, carotid surgery, major amputation, and smokers were more likely to be on a BB at the time of discharge (P < 0.05). There was no significant difference in reinterventions when comparing patients with and without BB (P = 0.061). At 30-day follow-up, there was no significant difference between the 2 groups for any cause of reintervention. At 1-year follow-up, patients on BB were less likely to need reintervention for graft occlusion (no BB 18.70%, BB 11.77%, P = 0.002). There was no significant difference in reintervention for all other causes at 1-year follow-up. There was an increase in 30-day (no BB 0.20%, BB 0.33%, P = 0.007) and 1-year mortality (no BB 2.35%, BB 3.19%, P < 0.001) in patients on BBs. A time to event adjusted analysis based on Cox proportional hazard model revealed a 26% higher risk of 1-year mortality for patients on BB (hazard ratio: 1.26 [1.10-1.41] P < 0.001).
Despite theoretical benefits of BBs on aneurysm behavior, review of the largest national vascular surgery database shows that patients on BBs do not have lower incidence of endovascular reinterventions after EVAR while additionally showing a higher mortality in this patient population.
血管内主动脉瘤修复术（EVAR）后瘤囊行为的预测因素以及瘤囊行为对长期生存的影响尚不清楚。研究β受体阻滞剂（BBs）对瘤囊行为影响的多中心试验有限。在患有结缔组织疾病的患者和普通人群中，BBs一直未能显示出对腹主动脉瘤瘤囊消退有益。本研究旨在评估EVAR后BBs与瘤囊行为之间的关联。
对在血管质量改进计划（2003 - 2021年）中登记接受EVAR的患者进行分层，分为出院时使用BBs组和未使用BBs组，并在30天和1年随访时进行评估。主要结局包括30天和1年时的死亡率和再次干预情况。在规定的时间终点也研究了再次干预的原因。对分类变量和连续变量分别分析两组之间的关联。P值<0.05被认为具有统计学意义。
共研究了50411例患者，分为使用BBs组（28866例；57.3%）和未使用BBs组（21545例；42.7%）。患有高血压、糖尿病、慢性阻塞性肺疾病、冠状动脉疾病、既往有冠状动脉旁路移植术或经皮冠状动脉介入治疗史、既往血管成形术或支架植入术、下肢旁路移植术、颈动脉手术、大截肢手术以及吸烟者在出院时更有可能使用BBs（P<0.05）。比较使用和未使用BBs的患者，再次干预情况无显著差异（P = 0.061）。在30天随访时，两组因任何再次干预原因均无显著差异。在1年随访时，使用BBs的患者因移植物闭塞需要再次干预的可能性较小（未使用BBs组为18.70%，使用BBs组为11.77%，P = 0.002）。在1年随访时，所有其他原因的再次干预情况无显著差异。使用BBs的患者30天死亡率（未使用BBs组为0.20%，使用BBs组为0.33%，P = 0.007）和1年死亡率（未使用BBs组为2.35%，使用BBs组为3.19%，P<0.001）均有所增加。基于Cox比例风险模型的事件时间调整分析显示，使用BBs的患者1年死亡风险高26%（风险比：1.26 [1.10 - 1.41]，P<0.001）。
尽管BBs对动脉瘤行为有理论上的益处，但对最大的国家血管外科数据库的回顾显示，EVAR后使用BBs的患者血管内再次干预发生率并未降低，而且该患者群体死亡率更高。
