Blood group is a long-term cardiovascular risk factor after carotid endarterectomy
Filipa Jácome1,2, Mariana Basílio Martins1, Alexandre Sarmento2
1Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.
Insights
Blood type influences cardiovascular risk after carotid endarterectomy. Non-O blood types show higher long-term risks of major adverse cardiovascular events, while Rh-negative patients face increased perioperative risks.
Area of Science:
- Vascular Surgery
- Cardiology
- Blood Group Genetics
Background:
- ABO blood group is linked to cardiovascular disease risk.
- Rhesus (Rh) factor also shows preliminary associations with cardiovascular outcomes.
- Carotid endarterectomy (CEA) is a procedure to treat carotid artery stenosis.
Purpose of the Study:
- To investigate the impact of ABO and Rh blood groups on short- and long-term outcomes following CEA.
- To analyze the association between blood type and major adverse cardiovascular events (MACE), mortality, and perioperative complications.
- To identify potential risk stratification strategies based on blood group.
Main Methods:
- Prospective follow-up of 184 patients undergoing CEA for atherosclerotic carotid stenosis (2012-2019).
- Primary outcomes: long-term MACE and all-cause mortality. Secondary outcomes: perioperative complications and myocardial injury after non-cardiac surgery (MINS).
- Time-to-event analysis used to assess the effect of ABO and Rh groups.
Main Results:
- Non-O blood types were associated with a higher incidence of coronary artery disease (OR: 2.313, p=0.008).
- Rh-positive patients had more congestive heart failure (14.7%, p=0.03).
- Long-term MACE incidence was higher in non-O patients (aHR: 2.034, p=0.040), and perioperative MINS was more common in Rh-negative patients.
Conclusions:
- Non-O blood type is associated with increased long-term MACE after CEA.
- Rh-negative blood type is linked to a higher incidence of 30-day MINS.
- Preoperative cardiac evaluation may need to be more comprehensive for specific blood groups.
Background:
ABO blood group system has been clinically related to an increased incidence of cardiovascular diseases. Preliminary data relating Rhesus (Rh) factor and these outcomes also have been published. Our aim was to analyse the impact of blood group on the short and long-term outcomes after carotid endarterectomy (CEA).
Materials And Methods:
From 2012 to 2019, patients from a referral centre who underwent CEA for atherosclerotic carotid stenosis were prospectively followed. Our primary outcomes were long-term major adverse cardiovascular events (MACEs) and all-cause mortality. Secondary outcomes were perioperative complications and myocardial injury after non-cardiac surgery (MINS). Median follow-up was 50 months (interquartile range 21-69). Time-to-event analysis was used to determine the effect of ABO and Rh groups in long-term outcomes.
Results:
One hundred and eighty-four patients were included, with a mean age of 70.1 ± 9.1 years. Eighteen (25.7%) patients with O type and 48 (42.1%) patients with non-O type presented coronary artery disease (odds ratio [OR]: 2.313, 5-95% confidence interval (CI) 1.245-4.297, p = .008). Patients Rh+ presented significantly more congestive heart failure, 23 (14.7%), p = .03. The incidence of MACE in the long-term was higher in non-O patients (adjusted hazard ratio: 2.034; CI: 1.032-4.010, p = .040). Rh- patients, presented a higher incidence of perioperative MINS. However, there was no statistically significant association with long-term risk of MACE.
Conclusion:
The incidence of MACE in long-term analysis was higher in non-O blood type and 30-day MINS was significantly more common amongst Rh- patients. The benefit from a more complete preoperative cardiac study in these patients should be performed.
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