Takayasu's arteritis (TA) is a rare disease that can be overlooked during the first visit to a GP, rheumatologist, or any other medical specialist due to a variety of its symptoms. The aim of this study was to describe the clinical presentation and the course of patients with TA residing in the Middle Ural. A retrospective analysis was conducted using the medical records of 183 patients treated at the Sverdlovsk Regional Clinical Hospital 1 from 1979 through 2018. The male to female ratio was 1:3. The mean age was 33.5 years for women and 35.2 for men. The most frequently involved arteries were subclavian (101 cases; 55%), carotid (98 cases; 53%) and renal (77 cases; 42%). Type V was the most common angiographic type. Arterial stenosis was present in 94 (51%) patients. Sixty-six patients received surgical interventions. Of all patients included in the analysis, 31 died. The observed 5-year survival was 92%, 10-year survival, 90% and 15-year survival, 80%. Seventy-two patients (39%) developed major adverse cardiovascular events (MACE), including myocardial infarction, ischemic stroke, and thrombosis of large arteries/veins. The clinical presentation of TA may vary in different geographical regions.
Цель. Проанализировать структуру и предикторы сердечнососудис тых осложнений (ССО) у пациентов, страдающих артериитом Такаясу (АТ). Материал и методы. Обследованы 183 больных АТ, проходивших лечение в Свердловской клинической областной больнице № 1 в период с 01.01.1979 по 31.04.2018гг, и проанализированы результаты 22 аутопсий пациентов с АТ, умерших за этот же промежуток времени. Результаты. По данным ретроспективного исследования 72 (39%) пациентов из 183 имели ССО. Согласно результатам, неблагоприятными предикторами ССО оказались: мужской пол (p=0,002), курение (p=0,002), оперативные вмешательства до развития события (p=0,002), артериальная гипертензия (p=0,011), симптомы коронариита (p<0,001), головная боль в дебюте заболевания (p=0,028). В структуре причин смерти превалировали сосудистые осложнения-82% случаев. По данным материалов аутопсий у 21 (96%) пациента были обнаружены ате-росклеротические поражения артерий в сочетании со специфическими для АТ изменениями. Тромбозы артерий и вен были выявлены у 17 (77%) пациентов. Заключение. Пациенты с АТ имеют высокий риск развития тяжелых ССО, вплоть до летальных, и требуют особого внимания врача к мерам профилактики. Ключевые слова: артериит Такаясу, сосудистые осложнения, тромбоз, предикторы, оценка риска. Конфликт интересов: не заявлен.
Aim. To assess the effect of late diagnosis on survival and risk of vascular complications in Takayasu's arteritis (TA) patients. Methods. 183 patients with TA who were treated at the Sverdlovsk Regional Clinical Hospital No. 1 during the period from 01.01.1979 to 31.04.2018 were examined. There were 139 women and 44 men included, median age at the time of diagnosis being 35 [24; 44] years in females and 34 [26.5; 42] years in males and a median interval from the first symptoms onset to the diagnosis of 3 [1; 7] and 4 [1.5; 8] years respectively. The diagnosis of TA met the ACR criteria (1990).Results. During the follow-up period, 31 deaths were observed (18 in males and 13 in females). The median age of death for women was 36 [32-44] years, for men - 50 [40-57] years. Cardiovascular complications were recorded in 72 patients (27 men and 45 women). Vascular complications and namely acute cerebrovascular accident observed in 31 (43%) patients, including ischemic stroke in 24 (35%), transient ischemic attack in 3 (3%) and hemorrhagic stroke in 4 (6%) were the most frequent. Arterial thromboses were registered in 32 (44%) cases. In 162 (88.5%) patients, the diagnosis was established more than six months after the appearance of the first symptoms.At the primary physician visit in 71 (39%) patients, the initial diagnosis was erroneous. The most common symptoms they had were regarded as a manifestation of arterial hypertension (in 18% cases). 4 years or more interval from the onset of TA symptoms to diagnosis was associated with a significant cardiovascular events odds increase (OR=1.8; 95% CI: 1.07-3.34) and premature death by the 5th year of follow-up (OR=2.9; 95% CI: 1,27-6,55).Conclusion. In the retrospective TA cohort setting, late diagnosis verification and delayed treatment initiation were associated with an increased risk of premature death and severe vascular complications, described earlier in other samplings. Timely diagnosis and as early as possible appropriate treatment administration can prevent the disease progression and disabling complications occurrence.
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