退伍军人事务卫生系统中的上升胸腔大动脉动脉瘤:纵向结果和危险因素
Axel Gomez1, William Carroway1, Sally Tu1
1Division of Adult Cardiac Surgery and Lung Transplantation, Department of Surgery University of California San Francisco and San Francisco VA Health Care System San Francisco CA USA.
Journal of the American Heart Association
|January 14, 2026
概括
上升胸前动脉动脉瘤 (ATAA) 的全因死亡率随直径显著增加,特别是在5.5厘米或更大的动脉瘤中. 结果支持预防性ATAA修复的5.5厘米门.
科学领域:
- 心血管外科心血管外科
- 血管外科 血管外科
- 主动脉疾病 主动脉疾病
背景情况:
- 上升胸前动脉动脉瘤 (ATAA) 修复时间受到争议,通常以直径值为指导.
- ATAA的最佳外科干预时间尚不清楚.
- 需要对大型退伍军人队列中的ATAA结果进行分析.
研究的目的:
- 在大型退伍军人队伍中分析上升胸前大动脉动脉瘤 (ATAA) 的结果.
- 评估ATAA直径与全因死亡率之间的关联.
- 为了告知预防性ATAA修复的最佳时间.
主要方法:
- 从1998年到2024年,对764名患有ATAA (直径≥4.0厘米) 的退伍军人进行了回顾性队列研究.
- 结果包括手术修复,全因死亡率和大动脉事件.
- 细灰竞争风险回归分析了与基线直径相关的死亡风险,调整为共变量.
主要成果:
- 随着ATAA直径,全因死亡率显著增加,从2.83例/100人/年 (4.0-4.4厘米) 增加到24.6例/100人/年 (≥5.5厘米).
- 增加ATAA直径 (每0.5厘米增加1.36的aSHR) 和年龄 (每年1.07的aSHR) 独立地与全因死亡率相关.
- 大动脉剖析发生在0.3%的患者中,仅限于直径为4.0-4.5厘米的组.
结论:
- 上升胸前动脉动脉瘤 (ATAA) 的死亡率随直径增加而增加,显示动脉瘤≥5.5厘米的7倍增加.
- 这些发现支持了预防性ATAA修复的5.5厘米直径值.
- 对于较小的ATAA,选择性干预策略被强调.
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