The vital prognosis of subclavian stenosis
The vital prognosis of subclavian stenosis
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DOI：
10.1016/j.jacc.2006.09.055
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发表时间：
2007-04-10
影响因子：
24
通讯作者：
Fronek, Arnost
中科院分区：
文献类型：
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作者：
Aboyans, Victor;Criqui, Michael H.;Fronek, Arnost
目的本研究旨在评估锁骨下动脉狭窄（SS）的预后，作为总死亡率和心血管疾病（CVD）死亡率的潜在标志。背景锁骨下动脉狭窄（通过肱动脉收缩压差（BSPD）>= 15 mm Hg诊断）与心血管疾病危险因素患病率增加相关。然而，SS和死亡率之间的关系尚不清楚。我们假设BSPD >= 15 mm Hg将预测CVD事件的风险增加。其中两名来自非侵入性血管实验室，第三名是社区居民。多变量生存模型被用来测试一个独立的关联SS与总和CVD mortality.Results基线和随访数据（平均9.8年）是完整的1,778名参与者。锁骨下动脉狭窄157例（8.8%）。校正年龄、性别、种族和来源队列后，SS的存在与总死亡率和CVD死亡率的增加显著相关（分别为风险比[HR] 1.42，p < 0.005; HR 1.50，p = 0.05）。在调整CVD危险因素（吸烟包年数、高血压、糖尿病、总/高密度脂蛋白胆固醇比和体重指数）以及降脂和抗血小板治疗后，这种相关性仍然存在（总死亡率和CVD死亡率分别为HR 1.40，p < 0.01和HR 1.57，p < 0.05）。当模型中加入任何CVD病史或踝臂指数< 0.90时，SS仍然是总死亡率的独立预测因子（HR 1.34，p = 0.02），CVD死亡率趋势相似（HR 1.43，p = 0.09）。结论SS的存在很容易通过比较左右臂收缩压来诊断，预测总死亡率和CVD死亡率独立于CVD危险因素和基线时存在的CVD。
Objectives This study sought to assess the prognosis of subclavian stenosis (SS) as a potential marker of total and cardiovascular disease (CVD) mortality.Background Subclavian stenosis, diagnosed by a brachial systolic pressure difference (BSPD) >= 15 mm Hg, is associated with an increased prevalence of CVD risk factors. However, the association between SS and mortality is unknown. We hypothesized that a BSPD >= 15 mm Hg would predict an increased risk of CVD events.Methods We analyzed baseline and longitudinal data from 3 cohorts. Two were recruited from noninvasive vascular laboratories, and the third was a community-dwelling cohort. Multivariate survival models were used to test for an independent association of SS with total and CVD mortality.Results Baseline and follow-up data (mean 9.8 years) were complete in 1,778 participants. Subclavian stenosis was found in 157 (8.8%) subjects. Adjusted for age, gender, ethnicity, and cohort of origin, the presence of SS was significantly associated with increased total and CVD mortality (respectively, hazard ratio [HR] 1.42, p < 0.005; and HR 1.50, p = 0.05). This association persisted after adjustments for CVD risk factors (smoking pack-years, hypertension, diabetes, total/high-density lipoprotein cholesterol ratio, and body mass index) as well as lipid-lowering and antiplatelet therapies (HR 1.40, p < 0.01; and HR 1.57, p < 0.05 for total and CVD mortality, respectively). When any history of CVD or an ankle-brachial index < 0.90 were added to the model, SS remained an independent predictor for total mortality (HR 1.34, p = 0.02), with a similar trend for CVD mortality (HR 1.43, p = 0.09).Conclusions The presence of SS, easily diagnosed by comparing systolic pressures in the left and right arm, predicts total and CVD mortality independent of both CVD risk factors and existent CVD at baseline.