Serum Ionized Calcium as a Prognostic Biomarker in Type B Aortic Dissection After Endovascular Treatment.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Journal of Endovascular Therapy Pub Date : 2025-02-01 Epub Date: 2023-05-09 DOI:10.1177/15266028231168348
Hongqiao Zhu, Bei Hu, Heng Zhang, Haiyan Li, Jian Zhou, Zaiping Jing
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Abstract

Objective: Lower serum ionized calcium (iCa2+) was reported to be associated with a higher risk of adverse events in patients with cardiovascular diseases. This study aimed to investigate the associations between preoperative serum iCa2+ and outcomes of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR).

Methods: Between January 2016 and December 2019, 491 TBAD patients received TEVAR in a single center. Patients with acute or subacute TBAD were included. Serum iCa2+ (pH 7.4) was obtained from the arterial blood gas analysis before TEVAR. The study population was grouped into the hi-Ca group (1.11 mmol/L ≤ iCa2+ < 1.35 mmol/L) and lo-Ca group (iCa2+ < 1.11 mmol/L). The primary outcomes were all-cause mortality. The secondary outcomes were any major adverse clinical events (MACEs), which included all-cause mortality and aortic-related severe complications. To eliminate bias, 1:1 propensity score matching (PSM) was conducted.

Results: Overall, 396 TBAD patients were included in this study. In the total population, there were 119 (30.1%) patients in the lo-Ca group. After PSM, 77 matched pairs were obtained for further analysis. In the matched population, the 30-day mortality and 30-day MACEs between the two groups presented significant differences (p=0.023 and 0.029, respectively). At 5 years, cumulative incidences of mortality (log-rank p<0.001) and MACEs (log-rank p=0.016) were significantly higher in the lo-Ca group than that of the hi-Ca group. Multivariate cox regression analysis indicated that lower preoperative iCa2+ (hazard ratio for per 0.1 mmol/L decrease, 2.191; 95% confidence interval, 1.487-3.228, p<0.001) was an independent risk factor for 5-year mortality after PSM.

Conclusions: Lower preoperative serum iCa2+ might have an association with 5-year mortality in TBAD patients after TEVAR. Serum iCa2+ monitoring in this population may facilitate the identification of critical conditions.

Clinical impact: Our present study found that the cutoff value of preoperative serum iCa2+ 1.11 mmol/L, which is slightly lower than the lower limit of the normal range of 1.15-1.35 mmol/L, worked relatively well for discerning the high-risk and low-risk TBAD patients at 5 years. Serum iCa2+ monitoring in TBAD patients receiving TEVAR may facilitate the identification of critical conditions.

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血清离子钙作为B型主动脉夹层血管内治疗后的预后生物标志物。
目的:据报道,较低的血清离子钙(iCa2+)与心血管疾病患者不良事件的高风险相关。本研究旨在探讨B型主动脉夹层(TBAD)患者接受胸腔血管内主动脉修复(TEVAR)手术后术前血清iCa2+水平与预后的关系。方法:2016年1月至2019年12月,491例TBAD患者在单一中心接受TEVAR治疗。包括急性或亚急性TBAD患者。TEVAR术前动脉血气分析血清iCa2+ (pH 7.4)。研究人群分为高钙组(1.11 mmol/L≤iCa2+ < 1.35 mmol/L)和低钙组(iCa2+ < 1.11 mmol/L)。主要结局为全因死亡率。次要结局是任何主要不良临床事件(mace),包括全因死亡率和主动脉相关严重并发症。为了消除偏差,进行了1:1的倾向评分匹配(PSM)。结果:本研究共纳入396例TBAD患者。在总人口中,低钙组有119例(30.1%)患者。经PSM处理,获得77对配对,供进一步分析。在匹配人群中,两组30天死亡率和30天mace差异有统计学意义(p分别=0.023和0.029)。5年时,每降低0.1 mmol/L的累积死亡率(log-rank p2+)风险比为2.191;结论:术前血清iCa2+水平较低可能与TBAD患者TEVAR术后5年死亡率相关。在这一人群中监测血清iCa2+可能有助于危重病情的识别。临床影响:本研究发现术前血清iCa2+ 1.11 mmol/L的临界值略低于正常范围1.15-1.35 mmol/L的下限,对于5年TBAD患者的高危和低危区分效果较好。在接受TEVAR治疗的TBAD患者中监测血清iCa2+可能有助于危重病情的识别。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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