Editor's Choice - Association between Pre-operative Disease Activity and Long Term Revascularisation Outcomes in Patients with Takayasu's Arteritis: A Multicentre Retrospective Cohort Study.

Abstract

Current guidelines recommend postponing surgical intervention in patients with Takayasu's arteritis (TAK) until the disease becomes quiescent, which could exacerbate the incidence of pre-operative adverse events. Considering advances in peri-operative management, the association between pre-operative disease activity and long term prognosis after revascularisation requires re-evaluation. This was a multicentre, retrospective cohort study conducted across six tertiary Chinese centres, including patients receiving revascularisation procedures for arterial stenosis or occlusion due to TAK between August 2016 and January 2024. Kaplan-Meier survival analyses, Cox proportional hazards regression, and subgroup analyses were performed to evaluate the relationship between pre-operative disease activity and long term outcomes. Potential prognostic risk factors associated with clinical outcomes were identified using Cox regression analysis and receiver operating characteristic curve analysis. The outcomes of 165 consecutive patients with TAK who underwent 201 surgical interventions, including 94 (46.8%) endovascular revascularisations (EVRs) and 107 (53.2%) open surgical revascularisations (OSRs), were analysed. Interestingly, pre-operative disease activity parameters (active state defined by the 2018 European Alliance of Associations for Rheumatology consensus, Kerr score, and biological inflammation) were of little relevance to the incidence of poor long term outcomes among patients undergoing either EVR or OSR. Moreover, peri-operative immunosuppressive treatment was a prognostic factor for favourable outcomes after EVR (hazard ratio [HR] 3.10, 95% confidence interval [CI] 1.20 - 8.75, p = .009), whereas pre-operative thrombin time showed a statistically significant negative correlation with the risk of poor long term outcomes following OSR over the eight year follow up (HR 0.81, 95% CI 0.70 - 0.94, p = .004; p of non-linearity = .42), with an optimal cutoff value of 13 seconds. These data indicated a lack of correlation between pre-operative disease activity and long term prognosis. Peri-operative immunosuppressive treatment and thrombin time should be considered in the clinical decision making and peri-operative management of patients undergoing EVR and OSR, respectively.