周辺動脈疾患の患者における主要な心血管および肢体の有害事象の予測要因とモデル
Pan Song1,2, Huarong Xiong2,3, Xiaoyan Quan2
1Department of Emergency Medicine, the Second Affiliated Hospital of Army Medical University, Chongqing municipality, China.
VASA. Zeitschrift fur Gefasskrankheiten
|September 2, 2025
まとめ
このレビューは,周辺動脈疾患 (PAD) の患者における主要な心血管および肢体の有害事象に影響を与える重要な要因を特定しています. また,既存の予測モデルを批判的に評価し,PADの管理のためのリスク評価と臨床的意思決定の改善の分野を強調しています.
科学分野:
- 心血管医学
- 血管 外科
- エピデミオロジー
背景:
- 周辺動脈疾患 (PAD) は,主要な心血管および肢体の有害事象 (MACEおよびMALE) のリスクを大幅に増加させる.
- PAD患者におけるMACEとMALEの予測要因と既存のモデルの性能については,さらなる明確化が必要である.
- これらの要因を理解することは 患者の治療結果を改善し 臨床戦略を導き出す上で 極めて重要です
研究 の 目的:
- PAD患者のMACEとMALEに影響を与える要因を体系的に特定する.
- PADにおけるMACEとMALEの既存の予測モデルの性能と方法論の質を批判的に評価する.
- 予測モデルの強化と臨床実践の情報提供のための勧告を提供すること.
主な方法:
- PubMed,Embase,Cochrane Libraryで広範な文献検索が行われました.
- データ抽出は,研究設計,患者の特徴,影響因子,予測モデルの詳細に焦点を当てた.
- 予測モデルの方法論的質とバイアスのリスクは,PROBASTツールを使用して評価されました.
主要な成果:
- 116の研究ではMACEの118の要因が特定され,55の研究ではMALEの88の要因が特定されました.
- 一般的なMACE要因には,年齢,喫煙,糖尿病,冠動脈疾患,BMI,ABI,eGFRが含まれています.
- 一般的なMALE要因には,年齢,喫煙,糖尿病,慢性腎疾患,高血圧,BMI,WIfI分類が含まれています.
- 6つの研究では予測モデルが開発/検証され,3つの研究ではバイアスのリスクが低く,3つの研究ではバイアスのリスクが不明/高かった.
結論:
- 多くの要因が PAD の MACE と MALE に影響を及ぼしますが,研究設計と焦点には大きな違いがあります.
- PADにおけるMACEとMALEの既存の予測モデルは質が異なるため,さらなる精細化が必要である.
- このレビューは予測要因とモデルの性能に関する証拠を統合し,将来の研究と臨床応用のための洞察を提供します.
関連する概念動画
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
34
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
34
01:30Peripheral Artery Disease I: Introduction
32
Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs, particularly the arteries supplying the thighs and calves. In rare cases, it may involve other arteries, including those in the arms.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty...
32
01:27Peripheral Artery Disease III: Interprofessional Care
29
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
29
01:26Peripheral Artery Disease IV: Nursing Management
43
The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
43
01:23Peripheral Artery Disease V: Postoperative Nursing Management
24
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
24
01:30Coronary Artery Disease I: Introduction
54
Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
54