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Zhao K, Niu J, He Y, Kong L, Zhao W, Lu Q, Li S, Zhou J. The role of geriatric nutritional risk index in predicting survival of type B aortic dissection patients after thoracic endovascular aortic repair. J Nutr Health Aging 2025; 29:100572. [PMID: 40373393 DOI: 10.1016/j.jnha.2025.100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 03/29/2025] [Accepted: 04/26/2025] [Indexed: 05/17/2025]
Abstract
BACKGROUND The geriatric nutritional risk index (GNRI) is a reliable indicator of patients' nutrition status and has been shown to be valuable in predicting the outcome of patients with various cardiovascular diseases. This study explored the association between perioperative GNRI and the prognosis of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR). METHODS A total of 1,157 consecutive patients who underwent TEVAR between January 2007 and August 2019 were included, with data from 789 patients analyzed. The GNRI was used to measure nutritional status. Patients were categorized into five groups based on the GNRI quintile. The study's endpoints included all-cause mortality, aortic-related adverse events (ARAEs), and major adverse cardiovascular and cerebrovascular events (MACCEs) at 30 days, 1 year, and 5 years. The univariate and multivariate Cox regression analyses the effect of GNRI on the endpoints. Kaplan-Meier survival analysis was conducted to assess the incidence of these endpoints across the five groups, and restricted cubic spline (RCS) analysis was used to examine the non-linear relationship between GNRI and all-cause mortality. RESULTS The Kaplan-Meier survival analyses revealed that the risk of 1-year and 5-year all-cause mortality was highest in the Q1 group among the five groups (P = 0.009 and P = 0.002, respectively). However, there was no significant difference in 1-year and 5-year ARAEs and MACCEs (all P > 0.05). Multivariate Cox analysis showed that continuous GNRI was independently associated with 5-year all-cause death (HR = 0.97, 95% CI: 0.95-1.00; P = 0.027). Compared with the Q1 group, the Q2 (HR = 0.22, 95% CI: 0.06-0.80; P = 0.021) and Q4 groups (HR = 0.26, 95% CI: 0.08-0.81; P = 0.020) had lower risks of 1-year all-cause mortality. The Q2 group (HR = 0.38, 95% CI: 0.18-0.83; P = 0.015) and Q3 group (HR = 0.46, 95% CI: 0.22-0.96; P = 0.039) were also observed to have a lower risk of 5-year all-cause mortality than the Q1 group. In the subgroup analyses, chronic kidney disease (CKD) showed significant interaction (P-interaction < 0.001). Besides, the RCS analysis identified a "U"-shaped relationship between GNRI and all-cause mortality of TBAD patients following TEAVR. CONCLUSIONS TBAD patients undergoing TEVAR showed a strong correlation between perioperative low GNRI and higher risks of 1-year and 5-year all-cause mortalities. TBAD patients with a too low GNRI should receive particular attention.
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Affiliation(s)
- Kaiwen Zhao
- Department of Vascular Surgery, Changhai Hospital of the Navy Medical University, Shanghai, China; Department of General Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Jinzhu Niu
- Department of Vascular Surgery, Changhai Hospital of the Navy Medical University, Shanghai, China
| | - Yuzhen He
- Department of Vascular Surgery, Changhai Hospital of the Navy Medical University, Shanghai, China
| | - Lingxu Kong
- Department of Vascular Surgery, The Third Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Wenyao Zhao
- College of Clinical Medicine, Jining Medical University, Jining, Shandong, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital of the Navy Medical University, Shanghai, China
| | - Shuangshuang Li
- Department of Vascular Surgery, The Third Affiliated Hospital of the Navy Medical University, Shanghai, China.
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital of the Navy Medical University, Shanghai, China; Department of Vascular Surgery, The Third Affiliated Hospital of the Navy Medical University, Shanghai, China.
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Liu LW, Cui YK, Zhang L, Jia DL, Wang J, Gu JW, Zhang JY, Dong Z, Jin XJ, Zou XY, Sun GL, Dai YX, Sun AJ, Ge JB. Effectiveness of chest pain center accreditation on the hospital outcome of acute aortic dissection: a nationwide study in China. Mil Med Res 2024; 11:62. [PMID: 39183322 PMCID: PMC11346265 DOI: 10.1186/s40779-024-00565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/09/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The National Chest Pain Center Program (NCPCP) is a nationwide, quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China. The benefits of chest pain center (CPC) accreditation on acute coronary syndrome have been demonstrated. However, there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection (AAD). METHODS We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China, using data from the NCPCP spanning the period from January 1, 2016 to December 31, 2022. The patients were divided into 2 groups: pre-accreditation and post-accreditation admissions. The outcomes examined included in-hospital mortality, misdiagnosis, and Stanford type A AAD surgery. Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes. Furthermore, we stratified the hospitals based on their geographical location (Eastern/Central/Western regions) or administrative status (provincial/non-provincial capital areas) to assess the impact of CPC accreditation on AAD patients across various regions. RESULTS The analysis encompassed a total of 40,848 patients diagnosed with AAD. The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis (12.1% vs. 16.3%, P < 0.001 and 2.9% vs. 5.4%, P < 0.001, respectively) as well as a notably higher rate of Stanford type A AAD surgery (61.1% vs. 42.1%, P < 0.001) compared with the pre-accreditation group. After adjusting for potential covariates, CPC accreditation was associated with substantially reduced risks of in-hospital mortality (adjusted OR 0.644, 95% CI 0.599-0.693) and misdiagnosis (adjusted OR 0.554, 95% CI 0.493-0.624), along with an increase in the proportion of patients undergoing Stanford type A AAD surgery (adjusted OR 1.973, 95% CI 1.797-2.165). Following CPC accreditation, there were significant reductions in in-hospital mortality across various regions, particularly in Western regions (from 21.5 to 14.1%). Moreover, CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities (adjusted OR 0.607 vs. 0.713). CONCLUSION CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.
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Affiliation(s)
- Li-Wei Liu
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Yi-Kai Cui
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Lin Zhang
- Department of Emergency and Critical Care Medicine, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Dai-Le Jia
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Jing Wang
- Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jia-Wei Gu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jin-Yan Zhang
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Zhen Dong
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Xue-Juan Jin
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
| | - Xiao-Yi Zou
- Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Guo-Li Sun
- Department of Cardiology, Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Yu-Xiang Dai
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Ai-Jun Sun
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China.
| | - Jun-Bo Ge
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China.
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Schizas N, Nazou G, Samiotis I, Antonopoulos CN, Angouras DC. Is TEVAR an Effective Approach to Prevent Complications after Surgery for Aortic Dissection Type A? A Systematic Review. Healthcare (Basel) 2024; 12:1263. [PMID: 38998798 PMCID: PMC11241072 DOI: 10.3390/healthcare12131263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
Introduction: A residual false lumen after treatment for Aortic Dissection type A (AD) has been associated with early complications, such as A malperfusion or rupture and mid-term or delayed complications, such as aneurysm formation or dissection expansion. Thoracic Endovascular Aortic Repair (TEVAR) is considered an effective solution by several surgical teams to prevent future complications. In this systematic review, all published data regarding the implementation of TEVAR after previous treatment for AD were collected in order to investigate indications, methods, clinical outcomes and aortic remodeling in these patients. Methods: The aim of this study was to investigate the indications, the methods and the efficacy of TEVAR usage after surgical treatment of AD. Data for this study were collected from four widely used medical databases (MEDLINE, SCIENCE DIRECT, GOOGLE SCHOLAR, OVID). All the results for each database were recorded and were analyzed with a systematic method. Techniques and clinical outcomes were investigated. Aortic remodeling was evaluated based on the following parameters in these studies: aortic diameter, true lumen diameter, false lumen diameter, false lumen thrombosis and false lumen patency. Results: The results obtained from the search among all databases comprised 1410 articles and of these articles 9 were included in the review. The majority of the studies were retrospective (seven out of nine studies), while no study was randomized. The total number of patients was 157 and 133 of them (84.7% of patients) were treated with TEVAR in zone 3 without extension below the diaphragm intraoperatively. Among 142 patients, the calculated mortality rate was 12.7% (18 of 142 patients), with 2.8% (4 of 142 patients) presenting with stroke. The percentage of patients with total or partial thrombosis combined was 65.9% (62 patients in a population of 92). The reintervention rate was 18.7%. Conclusions: TEVAR after AD surgery is an approach usually chosen in clinical practice, but the criteria of its usage are uncertain. This method is safe and enhances aortic remodeling with an acceptable reintervention rate. Definite guidelines in this field should be created in order to delineate whether TEVAR after AD surgery is beneficial as a preventive measure to aorta-related complications and to decide under which criteria this approach should be chosen.
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Affiliation(s)
- Nikolaos Schizas
- 4th Cardiac Surgery Department, Hygeia Hospital, 151 23 Marousi, Greece
- Department of Cardiac Surgery, Medical School, National and Kapodistrian University, 157 72 Athens, Greece
| | - Georgia Nazou
- Anesthesiology Department, Evangelismos General Hospital, 106 76 Athens, Greece
| | - Ilias Samiotis
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, 106 76 Athens, Greece
| | - Constantine N Antonopoulos
- Department of Vascular Surgery, Medical School, National and Kapodistrian University, 157 72 Athens, Greece
| | - Dimitrios C Angouras
- Department of Cardiac Surgery, Medical School, National and Kapodistrian University, 157 72 Athens, Greece
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