Eur Heart J:外周动脉疾病患者经血管内和手术血运重建的长期结局比较

2021-02-25 MedSci原创 MedSci原创

尽管两种治疗策略的长期MALE风险相当,但经手术血管重建具有降低长期死亡率的优势。

外周动脉疾病(PAD)可通过血管内治疗或开放手术的方法进行血运重建。尽管通过血管内治疗进行血运重建术的患者有所增加,但仍不确定哪种治疗策略能够获得更好的长期结局。

近日,心血管领域权威杂志Eur Heart J上发表了一篇研究文章,该回顾性队列研究评估了澳大利亚和新西兰住院的PAD患者,这些患者在2008年至2015年间接受了血管内血运重建术或外科手术治疗。研究人员使用倾向得分匹配分析进行了比较。研究人员排除了混合干预。该研究的主要终点是死亡或严重不良肢体事件(MALE),定义为住院后长达8年的急性肢体缺血、紧急外科手术或血管内再干预或重大截肢的复合终点。研究人员采用时间-事件分析了75189名 符合条件的患者(15239例手术患者和59950名血管内治疗患者),并从中确定了14339对配对患者(年龄均值±SD为71±12岁,男性占73%),且协变量平衡良好。

研究人员发现血管内治疗血运重建与合并的MALE或死亡率增加相关[风险比(HR)为1.13,95%置信区间(CI):1.09-1.17,P<0.001]。当血管内治疗与手术治疗相比,MALE(HR为1.04,95%CI:0.99-1.10,P=0.15)和全因紧急住院治疗(HR为1.01,95%CI:0.98-1.04,P=0.57)的风险相似,但死亡率较高(HR为1.16,95%CI:1.11-1.21,P<0.001)。在亚组分析中,这些发现与间歇性跛行和长期肢体缺血的临床表现均一致。

由此可见,尽管两种治疗策略的长期MALE风险相当,但经手术血管重建具有降低长期死亡率的优势。这与以前的PAD研究不一致,进一步凸显了这一领域存在的争议。

原始出处:

Saman L Parvar,et al.Long-term outcomes following endovascular and surgical revascularization for peripheral artery disease: a propensity score-matched analysis.European Heart Journal.2021.https://doi.org/10.1093/eurheartj/ehab116

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    2021-06-12 itsNine

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    2021-03-16 ms8000001919772209

    学习

    0

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    2021-02-27 柳叶一刀
  5. [GetPortalCommentsPageByObjectIdResponse(id=1799144, encodeId=f1011e99144f1, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, createdName=hmwwww, createdTime=Sun Feb 06 06:05:59 CST 2022, time=2022-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=972984, encodeId=13d89e2984cd, content=哈哈哈哈哈哈哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/KWnd8I8cR9xaRlNWnia4aKDlXqybAjsf6iclxNEyH5iaDSwb8tFdQL0YTibV22chrM1DFprBZ6OyvZWvaibKejibZHvA/132, createdBy=eeef2036569, createdName=itsNine, createdTime=Sat Jun 12 00:41:48 CST 2021, time=2021-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948524, encodeId=098d94852460, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a96b5454927, createdName=ms8000001919772209, createdTime=Tue Mar 16 00:15:04 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357659, encodeId=ed07135e6599f, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Sat Feb 27 13:05:59 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385127, encodeId=2ffa138512e69, content=<a href='/topic/show?id=99d99e03311' target=_blank style='color:#2F92EE;'>#长期结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97033, encryptionId=99d99e03311, topicName=长期结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Sat Feb 27 13:05:59 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563417, encodeId=92da156341e5c, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Feb 27 13:05:59 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593343, encodeId=83b6159334392, content=<a href='/topic/show?id=8d1342e95fa' target=_blank style='color:#2F92EE;'>#外周动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42795, encryptionId=8d1342e95fa, topicName=外周动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b27818121614, createdName=wujh_7312825, createdTime=Sat Feb 27 13:05:59 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=943839, encodeId=482b943839f6, content=有争议,但还是觉得手术开放治疗更好, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210226/f23705539a22465dad49b185641246f4/269e005bb68348558ceb01a4a8056073.jpg, createdBy=a54d5390453, createdName=T2DM终结者, createdTime=Fri Feb 26 22:37:56 CST 2021, time=2021-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=927245, encodeId=1c0392e245da, content=外周动脉疾病(PAD)可通过血管内治疗或开放手术的方法进行血运重建。, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=言西早, createdTime=Thu Feb 25 22:36:00 CST 2021, time=2021-02-25, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1799144, encodeId=f1011e99144f1, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, createdName=hmwwww, createdTime=Sun Feb 06 06:05:59 CST 2022, time=2022-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=972984, encodeId=13d89e2984cd, content=哈哈哈哈哈哈哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/KWnd8I8cR9xaRlNWnia4aKDlXqybAjsf6iclxNEyH5iaDSwb8tFdQL0YTibV22chrM1DFprBZ6OyvZWvaibKejibZHvA/132, createdBy=eeef2036569, createdName=itsNine, createdTime=Sat Jun 12 00:41:48 CST 2021, time=2021-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948524, encodeId=098d94852460, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a96b5454927, createdName=ms8000001919772209, createdTime=Tue Mar 16 00:15:04 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357659, encodeId=ed07135e6599f, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Sat Feb 27 13:05:59 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385127, encodeId=2ffa138512e69, content=<a href='/topic/show?id=99d99e03311' target=_blank style='color:#2F92EE;'>#长期结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97033, encryptionId=99d99e03311, topicName=长期结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Sat Feb 27 13:05:59 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563417, encodeId=92da156341e5c, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Feb 27 13:05:59 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593343, encodeId=83b6159334392, content=<a href='/topic/show?id=8d1342e95fa' target=_blank style='color:#2F92EE;'>#外周动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42795, encryptionId=8d1342e95fa, topicName=外周动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b27818121614, createdName=wujh_7312825, createdTime=Sat Feb 27 13:05:59 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=943839, encodeId=482b943839f6, content=有争议,但还是觉得手术开放治疗更好, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210226/f23705539a22465dad49b185641246f4/269e005bb68348558ceb01a4a8056073.jpg, createdBy=a54d5390453, createdName=T2DM终结者, createdTime=Fri Feb 26 22:37:56 CST 2021, time=2021-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=927245, encodeId=1c0392e245da, content=外周动脉疾病(PAD)可通过血管内治疗或开放手术的方法进行血运重建。, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=言西早, createdTime=Thu Feb 25 22:36:00 CST 2021, time=2021-02-25, status=1, ipAttribution=)]
    2021-02-27 slcumt
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    2021-02-26 T2DM终结者

    有争议,但还是觉得手术开放治疗更好

    0

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    2021-02-25 言西早

    外周动脉疾病(PAD)可通过血管内治疗或开放手术的方法进行血运重建。

    0

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