Antiplatelet Therapy, Abdominal Aortic Aneurysm Progression, and Clinical Outcomes.
Antiplatelet Therapy, Abdominal Aortic Aneurysm Progression, and Clinical Outcomes.
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DOI：
10.1001/jamanetworkopen.2023.47296
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发表时间：
2023-12-01
影响因子：
13.8
通讯作者：
Cameron, Scott J.
中科院分区：
文献类型：
--
作者：
Hariri, Essa;Matta, Milad;Layoun, Habib;Badwan, Osamah;Braghieri, Lorenzo;Owens III, A. Phillip;Burton, Robert;Bhandari, Rohan;Mix, Doran;Bartholomew, John;Schumick, David;Elbadawi, Ayman;Kapadia, Samir;Hazen, Stanley L.;Svensson, Lars G.;Cameron, Scott J.
这项队列研究评估了使用乙酰水杨酸与腹主动脉瘤患者的动脉瘤进展和长期临床结果之间的关系。阿司匹林的使用是否与腹主动脉瘤的进展和临床结果相关？在一项对3435名成年人进行的队列研究中，使用阿司匹林与腹主动脉瘤进展缓慢有关，特别是在男性参与者和不吸烟的人中。使用阿司匹林与10年后全因死亡率、大出血或动脉瘤夹层、破裂或修复的复合体无关。这些发现表明，在腹主动脉瘤患者中，使用阿司匹林来减缓动脉瘤的进展可能是合理的。临床前研究表明，阿司匹林在延缓腹主动脉瘤(AAA)进展和预防破裂方面具有潜在作用。人类研究中缺乏阿司匹林对AAA的临床益处的证据。目的：研究阿司匹林的使用与AAA患者的动脉瘤进展和长期临床结果之间的关系。这是一项回溯性的单中心队列研究。包括在克利夫兰诊所至少有两个可用的血管超声的成年患者，并排除有动脉瘤修复、夹层或破裂病史的患者。所有患者均随访10年。分析了2022年5月至2023年7月的数据。临床结果是首次发生全原因死亡率、大出血或夹层、破裂和修复的复合体。多变量调整的Cox比例风险回归用于估计全因死亡率的风险比(HR)，使用Fine和Gray比例风险回归的子风险比竞争风险回归用于大出血和综合结果的估计。通过使用多变量调整的线性回归比较动脉瘤直径的平均年化变化和使用Logistic回归比较快速进展的几率(每年直径变化和GT；每年0.5 cm)来评估动脉瘤的进展。共有3435名患者(平均年龄73.7[9.0]岁；2672名男性患者[77.5%]；120名亚裔、西班牙裔、美国印第安人或太平洋岛民患者[3.4%]；255名黑人患者[7.4%]；3060名白人患者[89.0%]；中位[智商]随访4.9[2.5-7.5]年)纳入最终分析，其中2150名(63%)被证实服用了处方阿司匹林。与未服用阿司匹林的患者相比，服用阿司匹林的患者的平均(SD)动脉瘤直径年化变化较慢(2.8vs3.8vs3.8[4.2]mm/年；P = .001)，并且发生快速动脉瘤进展的几率较低(调整后的优势比为0.64；95%可信区间为0.49-0.89；P = 为0.002)。使用阿司匹林与全因死亡风险(调整后的HR，0.92；95%CI，0.79-1.07；P = .32)无关，也与10年后的大出血(AHR，0.88；95%CI，0.76-1.03；P = .12)或综合结果(AHR，1.16；95%CI，0.93-1.45；P = .09)无关。在这项对3435名具有客观测量的主动脉瘤生长变化的临床队列患者的回顾性研究中，阿司匹林的使用与AAA进展缓慢显著相关，且具有良好的安全性。
This cohort study evaluates the association of acetylsalicylic acid use with aneurysm progression and long-term clinical outcomes in patients with abdominal aortic aneurysm. Is aspirin use associated with progression and clinical outcomes of abdominal aortic aneurysm? In a cohort study of 3435 adults, aspirin use was associated with slower progression of abdominal aortic aneurysm, particularly in male participants and nonsmokers. Aspirin use was not associated with all-cause mortality, major bleeding, or composite of aneurysm dissection, rupture, or repair at 10 years. These findings suggest that in patients with abdominal aortic aneurysm, the use of aspirin to slow aneurysm progression may be warranted. Preclinical studies suggest a potential role for aspirin in slowing abdominal aortic aneurysm (AAA) progression and preventing rupture. Evidence on the clinical benefit of aspirin in AAA from human studies is lacking. To investigate the association of aspirin use with aneurysm progression and long-term clinical outcomes in patients with AAA. This was a retrospective, single-center cohort study. Adult patients with at least 2 available vascular ultrasounds at the Cleveland Clinic were included, and patients with history of aneurysm repair, dissection, or rupture were excluded. All patients were followed up for 10 years. Data were analyzed from May 2022 to July 2023. Clinical outcomes were time-to-first occurrence of all-cause mortality, major bleeding, or composite of dissection, rupture, and repair. Multivariable-adjusted Cox proportional-hazard regression was used to estimate hazard ratios (HR) for all-cause mortality, and subhazard ratios competing-risk regression using Fine and Gray proportional subhazards regression was used for major bleeding and composite outcome. Aneurysm progression was assessed by comparing the mean annualized change of aneurysm diameter using multivariable-adjusted linear regression and comparing the odds of having rapid progression (annual diameter change >0.5 cm per year) using logistic regression. A total of 3435 patients (mean [SD] age 73.7 [9.0] years; 2672 male patients [77.5%]; 120 Asian, Hispanic, American Indian, or Pacific Islander patients [3.4%]; 255 Black patients [7.4%]; 3060 White patients [89.0%]; and median [IQR] follow-up, 4.9 [2.5-7.5] years) were included in the final analyses, of which 2150 (63%) were verified to be taking aspirin by prescription. Patients taking aspirin had a slower mean (SD) annualized change in aneurysm diameter (2.8 [3.0] vs 3.8 [4.2] mm per year; P = .001) and lower odds of having rapid aneurysm progression compared with patients not taking aspirin (adjusted odds ratio, 0.64; 95% CI, 0.49-0.89; P = .002). Aspirin use was not associated with risk of all-cause mortality (adjusted HR [aHR], 0.92; 95% CI, 0.79-1.07; P = .32), nor was aspirin use associated with major bleeding (aHR, 0.88; 95% CI, 0.76-1.03; P = .12), or composite outcome (aHR, 1.16; 95% CI, 0.93-1.45; P = .09) at 10 years. In this retrospective study of a clinical cohort of 3435 patients with objectively measured changes in aortic aneurysm growth, aspirin use was significantly associated with slower progression of AAA with a favorable safety profile.
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影响因子：
2.6
作者：
Chen, Chung-Yu;Huang, Jiann-Woei;Huang, Yaw-Bin
通讯作者：
Huang, Yaw-Bin
DOI：
10.1161/atvbaha.114.305115
发表时间：
2015-04-01
影响因子：
8.7
作者：
Shen, Mengcheng;Lee, Jiwon;Kassiri, Zamaneh
通讯作者：
Kassiri, Zamaneh
DOI：
10.1016/s1078-5884(98)80109-3
发表时间：
1998-06-01
影响因子：
5.7
作者：
Singh, K;Bonaa, KH;Bjork, L
通讯作者：
Bjork, L
影响因子：
1.5
作者：
Turowicz, Agnieszka;Kobecki, Jakub;Chabowski, Mariusz
通讯作者：
Chabowski, Mariusz
影响因子：
4.3
作者：
Raffort, Juliette;Hassen-Khodja, Reda;Lareyre, Fabien
通讯作者：
Lareyre, Fabien