JTCVS structural and endovascular · 2026
Prognostic value of endothelial activation and stress index (EASIX) on short-term and long-term outcomes in type B aortic dissection after thoracic endovascular repair: An observational study.
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Chen Xiaosi, Liu Min, Cai Dongqin, Liu Yuan, Xie Nianjin, Luo Songyuan, Luo Jianfang
Аннотация
OBJECTIVE: The association between endothelial activation and stress index (EASIX) and both short-term and long-term outcomes in patients with type B aortic dissection (TBAD) undergoing thoracic endovascular repair (TEVAR) remains unclear. This study aimed to explore this relationship.
METHODS: We conducted a retrospective analysis of 1090 patients with TBAD who underwent TEVAR. Patients were grouped into tertiles according to log2-transformed EASIX. Logistic and Cox regression, win ratio, landmark analysis, propensity score matching, and receiver operating characteristic analyses were performed to evaluate the prognostic and predictive value of EASIX for short-term and long-term outcomes.
RESULTS: A total of 172 (15.8%) patients experienced short-term adverse events, and 206 (18.9%) patients died during a median follow-up of 7.04 years. Logistic regression analyses indicated that greater EASIX levels were associated with an increased risk of composite end points (odds ratio, 1.69; 95% CI, 1.37-2.08; P < .001), as well as new-onset dialysis, organ ischemia, and 30-day death. In multivariable Cox regression analyses, EASIX was identified as an independent predictor of all-cause mortality (hazard ratio, 1.43; 95% CI, 1.23-1.68; P < .001). The combined models incorporating EASIX demonstrated superior predictive performance for short-term outcomes compared with the baseline models (DeLong test P < .05). Time-dependent receiver operating characteristic analysis revealed greater combined model area under the curves than baseline model for all-cause mortality at 1-, 3-, 5-, and 10-year follow-up (likelihood ratio test P < .001).
CONCLUSIONS: EASIX was associated with both short-term and long-term outcomes in patients with TBAD after TEVAR. Therefore, EASIX may serve as a supplementary indicator for risk stratification before intervention.
METHODS: We conducted a retrospective analysis of 1090 patients with TBAD who underwent TEVAR. Patients were grouped into tertiles according to log2-transformed EASIX. Logistic and Cox regression, win ratio, landmark analysis, propensity score matching, and receiver operating characteristic analyses were performed to evaluate the prognostic and predictive value of EASIX for short-term and long-term outcomes.
RESULTS: A total of 172 (15.8%) patients experienced short-term adverse events, and 206 (18.9%) patients died during a median follow-up of 7.04 years. Logistic regression analyses indicated that greater EASIX levels were associated with an increased risk of composite end points (odds ratio, 1.69; 95% CI, 1.37-2.08; P < .001), as well as new-onset dialysis, organ ischemia, and 30-day death. In multivariable Cox regression analyses, EASIX was identified as an independent predictor of all-cause mortality (hazard ratio, 1.43; 95% CI, 1.23-1.68; P < .001). The combined models incorporating EASIX demonstrated superior predictive performance for short-term outcomes compared with the baseline models (DeLong test P < .05). Time-dependent receiver operating characteristic analysis revealed greater combined model area under the curves than baseline model for all-cause mortality at 1-, 3-, 5-, and 10-year follow-up (likelihood ratio test P < .001).
CONCLUSIONS: EASIX was associated with both short-term and long-term outcomes in patients with TBAD after TEVAR. Therefore, EASIX may serve as a supplementary indicator for risk stratification before intervention.