RESUMEN
BACKGROUND: The aim of carotid interventions is to prevent cerebrovascular events. Endovascular treatment (carotid-artery-stenting/CAS) has become established as an alternative to open surgery in some cases. Historically, female sex has been considered as a perioperative risk factor, however, there are few studies regarding this hypothesis when it comes to CAS. OBJECTIVES: To analyze the CAS results in our center adjusted by sex. METHODS: A retrospective cohort study was designed, including patients with carotid atheromatosis operated at a single center from January 2016 to June 2019. Our objective was to compare cardiovascular risk, including myocardial infarction, stroke, and mortality, by sex. Follow-up rates of stent patency, restenosis, stroke, myocardial infarction, and death were reported. RESULTS: 71 interventions were performed in 50 men (70.42%) and 21 women (29.57%). Mean age was 70.50 ± 10.72 years for men and 73.62 ± 11.78 years for women. Cardiovascular risk factors did not differ significantly between sexes. Mean follow-up was 11.28 ± 11.28 months. There were no significant differences in neurological events during follow-up. No adverse cardiological events were detected at any time. Regarding the mortality rate, during medium-term follow up there were 2 neurological related deaths with no significant differences between sexes (p=0.8432). Neither sex had higher rated of restenosis during long term follow-up (5.63% vs. 1.41%, p = 0.9693) or reoperation (1.41% vs. 1.41%, p = 0.4971). All procedures remained patent (<50% restenosis). CONCLUSIONS: Despite the limitations of our study, CAS is a therapeutic option that is as effective and safe in women as in men. No sex differences were observed.
CONTEXTO: As intervenções carotídeas visam prevenir eventos cerebrovasculares. O tratamento endovascular (implante de stent na artéria carótida) se estabeleceu como uma alternativa à cirurgia aberta em alguns casos. Historicamente, o sexo feminino é considerado um fator de risco perioperatório, mas há poucos estudos abordando essa hipótese em casos de stent de carótida. OBJETIVOS: Analisar os resultados do CAS em nosso centro ajustados por sexo. MÉTODOS: Este estudo de coorte retrospectivo incluiu pacientes com ateromatose carotídea operados em um centro de janeiro de 2016 a junho de 2019. Nosso objetivo foi comparar o risco cardiovascular, incluindo infarto do miocárdio, acidente vascular cerebral e mortalidade, de acordo com o sexo. No seguimento, foram descritos patência do stent, reestenose, acidente vascular cerebral, infarto do miocárdio e morte. RESULTADOS: Setenta e uma intervenções foram realizadas: 50 homens (70,42%) e 21 mulheres (29,57%). A média de idade foi de 70,50 ± 10,72 anos nos homens e 73,62 ± 11,78 anos nas mulheres. Os fatores de risco cardiovascular não diferiram significativamente entre os sexos. A média de seguimento foi de 11,28 ± 11,28 meses. Durante o seguimento, não houve diferenças significativas nos eventos neurológicos. Nenhum evento cardiológico adverso foi detectado. Quanto à taxa de mortalidade, durante o seguimento de médio prazo ocorreram 2 óbitos neurológicos sem diferenças significativas entre os sexos (p = 0,8432). Não foi observada maior taxa de reestenose no seguimento de longo prazo (5,63% vs. 1,41%, p = 0,9693) ou de reoperação (1,41% vs. 1,41%, p = 0,4971) ao comparar os dois sexos. Todos os procedimentos permaneceram pérvios (< 50% de reestenose). CONCLUSÕES: Apesar das limitações deste estudo, o stent de carótida em mulheres é uma opção terapêutica tão eficaz e segura quanto em homens. Nenhuma diferença foi observada entre os sexos.
RESUMEN
Objetivo: Presentar nuestra experiencia y analizar la supervivencia de los pacientes hospitalizados con covid-19 y que desarrollaron algún proceso trombótico vascular.Material y métodosSe incluyó a todos los pacientes consecutivos con covid-19 que fueron atendidos durante los meses de marzo y abril de 2020 en nuestra institución. Se incluyó a pacientes sintomáticos con trombosis venosa profunda (TVP), tromboembolia pulmonar (TEP), ictus isquémico y trombosis arterial periférica (TAP) confirmados objetivamente. Se analizaron las curvas de supervivencia de todos los grupos mediante Kaplan-Meier, test de log rank y regresión de Cox.ResultadosDurante el periodo pandémico del 1 de marzo al 30 de abril, fueron atendidos 2.943 pacientes con covid-19 en nuestro centro. De ellos, 106 presentaron algún proceso trombótico vascular sintomático: 13 pacientes tuvieron TAP, 15 ictus, 20 TVP y 58 TEP; otros 11 pacientes mostraron trombosis vasculares múltiples. Aunque la edad media fue de 65 años, fueron de edad más avanzada los que mostraron trombosis arteriales que los que mostraron procesos tromboembólicos venosos. El 67,92% fueron hombres. En total, 25 pacientes murieron durante su ingreso hospitalario (23,58%), con diferencias entre grupos: fue más común en pacientes con TAP (9 pacientes de 13) e ictus isquémico (8 pacientes de 15), que en los de TVP (1 paciente de 20) o TEP (7 pacientes de 58).ConclusionesEl riesgo tromboembólico venoso en estos pacientes es mayor que el arterial, pero la trombosis arterial cuando aconteció estuvo asociada a altas tasas de mortalidad. La supervivencia fue mejor en los pacientes con TVP y TEP que en los pacientes con ictus isquémico o TAP. (AU)
Objective: To analyze the survival of patients hospitalized with covid-19 and who presented some vascular thrombotic complication.Material and methodsAll consecutive patients with covid-19 who were treated during the months of March and April 2020 at our institution were included. All patients were symptomatic and the thrombotic event objectively confirmed. Patients with deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, and peripheral arterial thrombosis (PAT) were included. Survival curves for all groups were analyzed using Kaplan-Meier with log rank test, and Cox regression.ResultsDuring the pandemic period from March-1 to April-30, 2943 patients were treated with confirmed covid-19 in our center. Of them, 106 patients showed some symptomatic vascular thrombosis: 13 patients had PAT, 15 ischemic stroke, 20 DVT and 58 PE. Another 11 patients presented multiple vascular thrombosis. Although the mean age was 65 years, there were differences between groups being older those patients with arterial thrombosis. A 67.92% were men. In total, 25 patients died during their hospital admission (23.58%), with differences between groups, being more common in patients with PAT (9 patients out of 13) and ischemic stroke (8 patients out of 15), than in those with DVT (1 patient out of 20) or PE (7 patients out of 58).ConclusionsThe venous thromboembolic risk in these patients is greater than the arterial, but arterial thrombosis when it occurs was associated with high mortality rates. Survival was better in patients with DVT and PE than in patients with ischemic stroke or PAT. (AU)
Asunto(s)
Humanos , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , Infecciones por Coronavirus/epidemiología , Mortalidad Hospitalaria , Embolia Pulmonar/mortalidad , Embolia Pulmonar/virología , Factores de Riesgo , Pandemias , Hospitalización , España/epidemiologíaRESUMEN
PURPOSE: To analyze the survival of patients hospitalized with COVID-19 and who presented some vascular thrombotic complication. MATERIAL AND METHODS: All consecutive patients with COVID-19 who were treated during the months of March and April 2020 at our institution were included. All patients were symptomatic and the thrombotic event objectively confirmed. Patients with deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, and peripheral arterial thrombosis (PAT) were included. Survival curves for all groups were analyzed using Kaplan-Meier with Log Rank test, and Cox regression. RESULTS: During the pandemic period from March-1 to April-30, 2943 patients were treated with confirmed COVID-19 in our center. 106 patients showed some symptomatic vascular thrombosis: 13 patients had PAT, 15 ischemic stroke, 20 DVT and 58 PE. 11 patients presented multiple vascular thrombosis. Although the mean age was 65 years, there were differences between groups being older those patients with arterial thrombosis. A 67.92% were men. In total, 25 patients died during their hospital admission (23.58%), with differences between groups, being more common in patients with PAT (9 patients out of 13) and ischemic stroke (8 patients out of 15), than in those with DVT (1 patient out of 20) or PE (7 patients out of 58). CONCLUSIONS: The venous thromboembolic risk in these patients is greater than the arterial, but arterial thrombosis when it occurs was associated with high mortality rates. Survival was better in patients with DVT and PE than in patients with ischemic stroke or PAT.
OBJETIVO: Presentar nuestra experiencia y analizar la supervivencia de los pacientes hospitalizados con COVID-19 y que presentaron algún proceso trombótico vascular. MATERIAL Y MÉTODOS: Se incluyeron todos los pacientes consecutivos COVID-19 que fueron atendidos durante los meses de marzo-abril 2020 en nuestra institución. Se incluyeron pacientes sintomáticos con trombosis venosa profunda (TVP), tromboembolia pulmonar (TEP), ictus isquémico y trombosis arterial periférica (TAP) confirmados objetivamente. Se analizaron las curvas de supervivencia de todos los grupos mediante Kaplan-Meier, test de Log Rank, y regresión de Cox. RESULTADOS: Durante el periodo pandémico del 1-marzo al 30-abril, se atendieron 2943 pacientes COVID-19 en nuestro centro. 106 pacientes presentaron algún proceso trombótico vascular sintomático: 13 pacientes tuvieron TAP, 15 ictus, 20 TVP y 58 TEP. 11 pacientes mostraron trombosis vasculares múltiples. Aunque la edad media fue de 65 años, fueron de edad más avanzada los que mostraron trombosis arteriales que procesos tromboembólicos venosos. El 67.92% fueron hombres. En total, 25 pacientes murieron durante su ingreso hospitalario (23.58%), existiendo diferencias entre grupos siendo más común en pacientes con TAP (9 pacientes de 13), e ictus isquémico (8 pacientes de 15), que en los de TVP (1 paciente de 20) o TEP (7 pacientes de 58). CONCLUSIONES: El riesgo tromboembólico venoso en estos pacientes es mayor que el arterial, pero la trombosis arterial cuando acontece estuvo asociada a altas tasas de mortalidad. La supervivencia fue mejor en los pacientes con TVP y TEP que en los pacientes con ictus isquémico o trombosis arterial periférica.
RESUMEN
OBJECTIVE: To analyze the survival of patients hospitalized with covid-19 and who presented some vascular thrombotic complication. MATERIAL AND METHODS: All consecutive patients with covid-19 who were treated during the months of March and April 2020 at our institution were included. All patients were symptomatic and the thrombotic event objectively confirmed. Patients with deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, and peripheral arterial thrombosis (PAT) were included. Survival curves for all groups were analyzed using Kaplan-Meier with log rank test, and Cox regression. RESULTS: During the pandemic period from March-1 to April-30, 2943 patients were treated with confirmed covid-19 in our center. Of them, 106 patients showed some symptomatic vascular thrombosis: 13 patients had PAT, 15 ischemic stroke, 20 DVT and 58 PE. Another 11 patients presented multiple vascular thrombosis. Although the mean age was 65 years, there were differences between groups being older those patients with arterial thrombosis. A 67.92% were men. In total, 25 patients died during their hospital admission (23.58%), with differences between groups, being more common in patients with PAT (9 patients out of 13) and ischemic stroke (8 patients out of 15), than in those with DVT (1 patient out of 20) or PE (7 patients out of 58). CONCLUSIONS: The venous thromboembolic risk in these patients is greater than the arterial, but arterial thrombosis when it occurs was associated with high mortality rates. Survival was better in patients with DVT and PE than in patients with ischemic stroke or PAT.
Asunto(s)
COVID-19/mortalidad , Mortalidad Hospitalaria , Embolia Pulmonar/virología , Accidente Cerebrovascular/virología , Trombosis/virología , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/complicaciones , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/mortalidad , Factores de Riesgo , España/epidemiología , Accidente Cerebrovascular/mortalidad , Análisis de Supervivencia , Trombosis/mortalidadRESUMEN
Abstract Background The aim of carotid interventions is to prevent cerebrovascular events. Endovascular treatment (carotid-artery-stenting/CAS) has become established as an alternative to open surgery in some cases. Historically, female sex has been considered as a perioperative risk factor, however, there are few studies regarding this hypothesis when it comes to CAS. Objectives To analyze the CAS results in our center adjusted by sex. Methods A retrospective cohort study was designed, including patients with carotid atheromatosis operated at a single center from January 2016 to June 2019. Our objective was to compare cardiovascular risk, including myocardial infarction, stroke, and mortality, by sex. Follow-up rates of stent patency, restenosis, stroke, myocardial infarction, and death were reported. Results 71 interventions were performed in 50 men (70.42%) and 21 women (29.57%). Mean age was 70.50 ± 10.72 years for men and 73.62 ± 11.78 years for women. Cardiovascular risk factors did not differ significantly between sexes. Mean follow-up was 11.28 ± 11.28 months. There were no significant differences in neurological events during follow-up. No adverse cardiological events were detected at any time. Regarding the mortality rate, during medium-term follow up there were 2 neurological related deaths with no significant differences between sexes (p=0.8432). Neither sex had higher rated of restenosis during long term follow-up (5.63% vs. 1.41%, p = 0.9693) or reoperation (1.41% vs. 1.41%, p = 0.4971). All procedures remained patent (<50% restenosis). Conclusions Despite the limitations of our study, CAS is a therapeutic option that is as effective and safe in women as in men. No sex differences were observed.
Resumo Contexto As intervenções carotídeas visam prevenir eventos cerebrovasculares. O tratamento endovascular (implante de stent na artéria carótida) se estabeleceu como uma alternativa à cirurgia aberta em alguns casos. Historicamente, o sexo feminino é considerado um fator de risco perioperatório, mas há poucos estudos abordando essa hipótese em casos de stent de carótida. Objetivos Analisar os resultados do CAS em nosso centro ajustados por sexo. Métodos Este estudo de coorte retrospectivo incluiu pacientes com ateromatose carotídea operados em um centro de janeiro de 2016 a junho de 2019. Nosso objetivo foi comparar o risco cardiovascular, incluindo infarto do miocárdio, acidente vascular cerebral e mortalidade, de acordo com o sexo. No seguimento, foram descritos patência do stent, reestenose, acidente vascular cerebral, infarto do miocárdio e morte. Resultados Setenta e uma intervenções foram realizadas: 50 homens (70,42%) e 21 mulheres (29,57%). A média de idade foi de 70,50 ± 10,72 anos nos homens e 73,62 ± 11,78 anos nas mulheres. Os fatores de risco cardiovascular não diferiram significativamente entre os sexos. A média de seguimento foi de 11,28 ± 11,28 meses. Durante o seguimento, não houve diferenças significativas nos eventos neurológicos. Nenhum evento cardiológico adverso foi detectado. Quanto à taxa de mortalidade, durante o seguimento de médio prazo ocorreram 2 óbitos neurológicos sem diferenças significativas entre os sexos (p = 0,8432). Não foi observada maior taxa de reestenose no seguimento de longo prazo (5,63% vs. 1,41%, p = 0,9693) ou de reoperação (1,41% vs. 1,41%, p = 0,4971) ao comparar os dois sexos. Todos os procedimentos permaneceram pérvios (< 50% de reestenose). Conclusões Apesar das limitações deste estudo, o stent de carótida em mulheres é uma opção terapêutica tão eficaz e segura quanto em homens. Nenhuma diferença foi observada entre os sexos.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Arterias Carótidas/cirugía , Placa Aterosclerótica/cirugía , Procedimientos Endovasculares/efectos adversos , Factores de Riesgo de Enfermedad Cardiaca , Grado de Desobstrucción Vascular , Stents , Factores Sexuales , Estudios Retrospectivos , Procedimientos Endovasculares/mortalidad , Oclusión de Injerto VascularRESUMEN
BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and its prevalence rate significantly increases with age. The prognostic implication of AF in surgical patients with peripheral arterial disease (PAD) has not been analyzed. The aims of this study were to analyze the prevalence of AF among patients operated on with symptomatic PAD, and to determine whether these patients are at a higher risk of death or amputation. METHODS: We designed a retrospective cohort study, from January 2013 to December 2017, in which we analyzed the medical records of all consecutive patients with symptomatic PAD admitted to our hospital and underwent a vascular procedure. We compared the outcomes of patients with and without AF. All statistically significant demographic variables that underwent a univariate analysis were inserted in the stepwise multivariate model along with AF. A survival analysis was performed to evaluate the factors associated with mortality through a Cox regression model. P-value of 0.05 was considered statistically significant. RESULTS: Four hundred three patients were admitted in-hospital with symptomatic PAD and they underwent a vascular intervention. The mean follow-up was 2 years. Seventy-six patients (18.8%) had AF. These patients were older (78 ± 9.1 years) than the 327 patients without AF (68 ± 12.37 years) (P < 0.0001), and more likely to undergo emergency surgery (18.42% vs. 7.34%, P = 0.0029). Age and emergency admission were dependent associates of AF. The patients with AF were frequently men (69.7%) with previous hypertension (96% %). The presence of AF was associated with higher rate of all-cause mortality (55.26%, P < 0.0001, hazard ratio 2.24, confidence interval 1.55-3.25), but the multivariate analysis adjusted for risk factors showed that the mortality was only associated with age because these patients were older and with many comorbidities. The majority of this population with AF showed some tissue lesion when they were admitted in-hospital (Rutherford V-VI, AF 80.2%, P = 0.0004), and this fact justified that a 22.36% underwent a major amputation affecting the ischemic lower limb in admission (P = 0.018). During the follow-up the free amputation rate was similar between groups (60.5% AF vs. 78.3% non-AF). CONCLUSIONS: This study showed the high prevalence of AF in patients with symptomatic PAD that required surgical admission in-hospital. The presence of AF was related with a greater and serious risk of mortality, but this was independently associated to age, because patients with AF were older and frailer. Clearly, this group of patients had a high risk of amputation when they arrived to the hospital and they needed emergency surgery.