选择性AAA修复后持续高的长期过度死亡率,特别是在女性中:一项基于人口的大型研究
Ruth M A Bulder1, Joost R van der Vorst1, Jan van Schaik1
1Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Annals of surgery
|July 27, 2023
概括
在接受选择性腹腔大动脉瘤 (AAA) 修复的患者中,长期死亡率仍然很高,特别是在女性中. 尽管治疗进展,心血管风险仍然存在,这突显了AAA结果中的性别差异.
科学领域:
- 血管外科 血管外科
- 心血管流行病学心血管流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 瑞典人口数据显示,在选择性修复后的腹腔大动脉动脉瘤 (AAA) 患者中,长期死亡率持续高.
- 尽管在内血管动脉瘤修复 (EVAR) 和心血管风险管理方面取得了进展,但这种趋势仍然存在.
- 不确定性存在于这是否反映了低于最佳的治疗,不断变化的患者人口统计学,或一个国家模式.
研究的目的:
- 估计选择性修复后腹腔大动脉动脉瘤 (AAA) 患者的长期过度死亡率和心血管风险.
- 分析随着时间的推移,AAA管理和患者选择的变化.
- 调查长期结果中的性别和年龄差异.
主要方法:
- 在全国范围内对40730名接受选择性AAA修复 (1995-2017) 的患者进行了时间趋势分析.
- 三个时间框架的比较,反映了EVAR使用和心血管风险管理的变化.
- 过度死亡率的相对生存分析;心血管死亡与非心血管死亡的竞争风险分析.
主要成果:
- 短期过度死亡率随着时间的推移显著改善.
- 长期过度死亡率仍然很高,女性的死亡风险翻了一番 (相对过度风险=1.87).
- 随着时间的推移,心血管死亡风险保持相似,女性更高;年龄不是一个重要因素. 患者人口变化对过度死亡率的影响最小 (2%).
结论:
- 接受选择性AAA修复的患者面临高长期过度死亡率和持续的心血管风险,无论治疗进展如何.
- 存在显著的性别差异,女性面临更高的长期死亡率.
- 没有观察到过度死亡率的年龄差异.
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