School of Medicine, University of Pittsburgh, United States.
School of Medicine, Stanford University, United States.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107958. doi: 10.1016/j.jstrokecerebrovasdis.2024.107958. Epub 2024 Aug 17.
Perioperative Large Vessel Occlusions (LVOs) occurring during and following surgery are of immense clinical importance. As such, we aim to present risk factors and test if the Society of Thoracic Surgery (STS) mortality and stroke risk scores can be used to assess operative risk.
Using data containing 7 index cardiac operations at a single tertiary referral center from 2010 to 2022, logistic and multivariate regression analysis was performed to identify factors that correlate to higher operative LVO and stroke rate. Odds ratios and confidence intervals were also obtained to test if the STS-Predicted Risk of Mortality (PROM) and -Predicted Risk of Stroke (PROS) scores were positively correlated to operative LVO and stroke rate.
Multivariate modeling showed primary risk factors for an operative LVO were diabetes (OR: 1.727 [95 % CI: 1.060-2.815]), intracranial or extracranial carotid stenosis (OR: 3.661 [95 % CI: 2.126-6.305]), and heart failure as defined by NYHA class (Class 4, OR: 3.951 [95 % CI: 2.092-7.461]; compared to Class 1). As the STS-PROM increased, the relative rate of LVO occurrence increased (very high risk, OR: 6.576 [95 % CI: 2.92-14.812], high risk, OR: 2.667 [1.125-6.322], medium risk, OR: 2.858 [1.594-5.125]; all compared to low risk). STS-PROS quartiles showed a similar relation with LVO risk (quartile 4, OR: 7.768 [95 % CI: 2.740-22.027], quartile 3, OR: 5.249 [1.800-15.306], quartile 2, OR:2.980 [0.960-9.248]; all compared to quartile 1).
Patients with diabetes, carotid disease and heart failure are at high risk for operative LVO. Both STS-PROM and -PROS can be useful metrics for preoperative measuring of LVO risks.
手术期间和手术后发生的围手术期大血管闭塞（LVOs）具有重要的临床意义。因此，我们旨在探讨相关风险因素，并检验胸外科医生协会（STS）死亡率和卒中风险评分是否可用于评估手术风险。
利用单中心 2010 年至 2022 年 7 项心脏索引手术的数据，采用逻辑回归和多变量回归分析，确定与较高手术 LVO 和卒中发生率相关的因素。还获得了比值比和置信区间，以检验 STS-预测死亡率（PROM）和-预测卒中风险（PROS）评分是否与手术 LVO 和卒中发生率呈正相关。
多变量建模显示，手术 LVO 的主要危险因素为糖尿病（OR：1.727[95%CI：1.060-2.815]）、颅内或颅外颈动脉狭窄（OR：3.661[95%CI：2.126-6.305]）和纽约心脏协会（NYHA）分级定义的心力衰竭（IV 级，OR：3.951[95%CI：2.092-7.461]；与 I 级相比）。随着 STS-PROM 的增加，LVO 发生的相对风险也随之增加（极高风险，OR：6.576[95%CI：2.92-14.812]；高风险，OR：2.667[1.125-6.322]；中风险，OR：2.858[1.594-5.125]；与低风险相比）。STS-PROS 四分位数与 LVO 风险也呈相似关系（四分位 4，OR：7.768[95%CI：2.740-22.027]；四分位 3，OR：5.249[1.800-15.306]；四分位 2，OR：2.980[0.960-9.248]；与四分位 1 相比）。
患有糖尿病、颈动脉疾病和心力衰竭的患者发生手术 LVO 的风险较高。STS-PROM 和-PROS 均可作为术前测量 LVO 风险的有用指标。
