Blood group is a long-term cardiovascular risk factor after carotid endarterectomy

Abstract

Background

ABO blood group system has been clinically related to an increased incidence of cardiovascular diseases. Preliminary data relating Rhesus (Rh) factor and these outcomes also have been published. Our aim was to analyse the impact of blood group on the short and long-term outcomes after carotid endarterectomy (CEA).

Materials and methods

From 2012 to 2019, patients from a referral centre who underwent CEA for atherosclerotic carotid stenosis were prospectively followed. Our primary outcomes were long-term major adverse cardiovascular events (MACEs) and all-cause mortality. Secondary outcomes were perioperative complications and myocardial injury after non-cardiac surgery (MINS). Median follow-up was 50 months (interquartile range 21–69). Time-to-event analysis was used to determine the effect of ABO and Rh groups in long-term outcomes.

Results

One hundred and eighty-four patients were included, with a mean age of 70.1 ± 9.1 years. Eighteen (25.7%) patients with O type and 48 (42.1%) patients with non-O type presented coronary artery disease (odds ratio [OR]: 2.313, 5–95% confidence interval (CI) 1.245–4.297, p = .008). Patients Rh⁺ presented significantly more congestive heart failure, 23 (14.7%), p = .03. The incidence of MACE in the long-term was higher in non-O patients (adjusted hazard ratio: 2.034; CI: 1.032–4.010, p = .040). Rh⁻ patients, presented a higher incidence of perioperative MINS. However, there was no statistically significant association with long-term risk of MACE.

Conclusion

The incidence of MACE in long-term analysis was higher in non-O blood type and 30-day MINS was significantly more common amongst Rh⁻ patients. The benefit from a more complete preoperative cardiac study in these patients should be performed.

Keywords:

• Carotid artery disease
• ABO blood-group system
• Rhesus blood-group system
• major adverse cardiac events
• survival analysis

Acknowledgements

The study was carried out at Centro Hospitalar Universitário de São João, EPE.

Author contributions

Study concept and design: FJ, MM, AS, AC, MDN, AK, PO, JA, and JRN. Data analysis and interpretation: FJ, MM, AS, AC, MDN, AK, PO, JA, and JRN. Data collection: FJ, AS, and JRN. Article writing: FJ, MM, AS, AC, MDN, AK, PO, JA, and JRN. Critical review: FJ, AS, AC, MDN, AK, PO, JA, and JRN. Final approval: FJ, AS, AC, MDN, AK, PO, JA, and JRN. Statistical analysis: FJ and JRN. Overall responsibility: JRN. All authors read and approved the final version.

Ethical approval

The protocol was approved by the Ethics Committee of our institution São João University Hospital Center, EPE/Faculty of Medicine of the University of Porto – Protocol number 248-18

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.