摘要
Background A number of studies have demonstrated the rates of overall and aneurysm-related mortality and morbidity in Western populations.The cardiovascular risk factors influencing postoperative outcome have been also reported.Until recently,little has been known about the prognosis in this patient cohort in the Chinese population.We evaluated the independent predictors of mortality and morbidity in abdominal aortic aneurysm （AAA） patients undergoing elective surgical treatment and emphasized whether the coronary artery revascularization could have any effect on the overall mortality and morbidity in patients following the current guideline recommendation.Methods A total of 386 patients （174 women） undergoing surgery in Beijing Anzhen Hospital from January 2008 to June 2010 were enrolled （mean age （70.6±10.5） years）.Kaplan-Meier curves were constructed to compare the mortality and morbidity of AAA patients with coronary artery revascularization and those without.A Cox proportional hazards model was constructed to identify clinical factors associated with two-year outcomes.The primary outcomes were death from any cause,the pre-specified morbidity was re-hospitalization for pulmonary conditions,congestive heart failure,angina,ischemic/hemorrhagic stroke.Results During the two-year follow-up,34 patients died and 65 experienced re-hospitalization with pulmonary conditions,congestive heart failure,angina,or ischemic/hemorrhagic stroke.Kaplan-Meier survival analysis showed that the AAA patients with cardiac revascularization had no higher incidence of overall mortality and major morbidity than those without （log-rank test P=0.35 and P=0.40,respectively）.Cox proportional hazards regression analysis showed that level of low-density lipoprotein （HR,4.06; 95％ CI：1.19-18.7,P=0.027） and AAA size （HR,2.18; 95％ CI：1.28-11.65,P=0.036） were independently associated with the incidence of overall mortality.Long-term use of angiotensin converting enzyme inhibitors,statins,AAA size and systolic blood pressure were independent predictors of the secondary pre-specified outcomes.Conclusions Coronary artery revascularization following the guideline recommendations did not increase the mortality and morbidity of Chinese with AAA who were undergoing repair.Absence of angiotensin converting enzyme inhibitors and statins,AAA size,and systolic blood pressure were powerful predictors of the clinical events.
Background A number of studies have demonstrated the rates of overall and aneurysm-related mortality and morbidity in Western populations.The cardiovascular risk factors influencing postoperative outcome have been also reported.Until recently,little has been known about the prognosis in this patient cohort in the Chinese population.We evaluated the independent predictors of mortality and morbidity in abdominal aortic aneurysm （AAA） patients undergoing elective surgical treatment and emphasized whether the coronary artery revascularization could have any effect on the overall mortality and morbidity in patients following the current guideline recommendation.Methods A total of 386 patients （174 women） undergoing surgery in Beijing Anzhen Hospital from January 2008 to June 2010 were enrolled （mean age （70.6±10.5） years）.Kaplan-Meier curves were constructed to compare the mortality and morbidity of AAA patients with coronary artery revascularization and those without.A Cox proportional hazards model was constructed to identify clinical factors associated with two-year outcomes.The primary outcomes were death from any cause,the pre-specified morbidity was re-hospitalization for pulmonary conditions,congestive heart failure,angina,ischemic/hemorrhagic stroke.Results During the two-year follow-up,34 patients died and 65 experienced re-hospitalization with pulmonary conditions,congestive heart failure,angina,or ischemic/hemorrhagic stroke.Kaplan-Meier survival analysis showed that the AAA patients with cardiac revascularization had no higher incidence of overall mortality and major morbidity than those without （log-rank test P=0.35 and P=0.40,respectively）.Cox proportional hazards regression analysis showed that level of low-density lipoprotein （HR,4.06; 95％ CI：1.19-18.7,P=0.027） and AAA size （HR,2.18; 95％ CI：1.28-11.65,P=0.036） were independently associated with the incidence of overall mortality.Long-term use of angiotensin converting enzyme inhibitors,statins,AAA size and systolic blood pressure were independent predictors of the secondary pre-specified outcomes.Conclusions Coronary artery revascularization following the guideline recommendations did not increase the mortality and morbidity of Chinese with AAA who were undergoing repair.Absence of angiotensin converting enzyme inhibitors and statins,AAA size,and systolic blood pressure were powerful predictors of the clinical events.
基金
This study was supported by grants from the Basic-Clinical Topics of Capital University of Medical Sciences （No.12JL58）,Anzhen Hospital President Fund （No.2012Z05 and No.2011F03） and the National Natural Science Foundation of China （No.81000130）.
