Mustafa Ahmad, Wei Chapman, Khan Shahkar, Rizvi Taqi, Grovu Radu, Khan Danyal, Dilluvio Brandon, Bjorklund Jessica, El-Sayegh Suzanne, Weinberg Mitchell
Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY.
Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, NY.
Medicine (Baltimore). 2024 Dec 27;103(52):e41017. doi: 10.1097/MD.0000000000041017.
Patients with renal artery stenosis (RAS) who fail medical management may be evaluated for Percutaneous transluminal renal artery angioplasty/stenting (PTRA/S). Comorbidities increasing the risk of complications following PTRA have not been explored well. Patients undergoing PTRA/S for RAS were sampled using National Inpatient Sample (NIS) Database. Demographics, length of stay (LOS), and comorbidities were gathered using ICD-10 codes. Complications included heart failure, myocardial infarction, cardiac arrest, major bleeding, stent thrombosis, renal artery dissection/embolism, aortic dissection/rupture and atheroembolism. Extended length of stay (ELOS) was defined as LOS >4 days. Univariate and multivariate logistic regression analyses were used to identify predictors for complications and ELOS. A sum of 517 patients underwent PTRA. Most prevalent comorbidities were peripheral vascular disease, coronary artery disease and dyslipidemia. On multivariate analysis, comorbidities significant for predicting major complications were end-stage renal disease, chronic liver disease, heart failure and coagulable disorders whereas comorbidities significant for predicting ELOS were age, chronic obstructive pulmonary disease, chronic kidney disease, anemia, chronic heart failure, and coagulable disorders. As we continue to identify the ideal candidates for PTRA, it is important to consider the comorbidities that predispose these patients to increased periprocedural complications and ELOS.
药物治疗无效的肾动脉狭窄（RAS）患者可接受经皮腔内肾动脉血管成形术/支架置入术（PTRA/S）评估。PTRA术后并发症风险增加的合并症尚未得到充分研究。利用国家住院患者样本（NIS）数据库对接受RAS的PTRA/S患者进行抽样。使用国际疾病分类第十版（ICD-10）编码收集人口统计学数据、住院时间（LOS）和合并症。并发症包括心力衰竭、心肌梗死、心脏骤停、大出血、支架血栓形成、肾动脉夹层/栓塞、主动脉夹层/破裂和动脉粥样硬化栓塞。延长住院时间（ELOS）定义为住院时间>4天。采用单因素和多因素逻辑回归分析确定并发症和ELOS的预测因素。共有517例患者接受了PTRA。最常见的合并症是外周血管疾病、冠状动脉疾病和血脂异常。多因素分析显示，预测主要并发症的显著合并症是终末期肾病、慢性肝病、心力衰竭和可凝血疾病，而预测ELOS的显著合并症是年龄、慢性阻塞性肺疾病、慢性肾病、贫血、慢性心力衰竭和可凝血疾病。在我们继续确定PTRA的理想候选者时，重要的是要考虑那些使这些患者围手术期并发症和ELOS增加的合并症。
