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JACC:经导管主动脉瓣置换术后急性冠脉综合征的发病率、临床特征和影响

2018-12-18 xiangting MedSci原创

中位随访25个月后,约十分之一接受TAVR的患者因ACS再次入院。

这项研究旨在评估TAVR后急性冠脉综合征(ACS)的发病率、预测因素、治疗和预后。

约一半接受经导管主动脉瓣置换术(TAVR)的患者同时患有冠脉疾病(CAD)。然而,TAVR后冠脉事件的发生和临床影响仍在很大程度上是未知的。

研究纳入2007年5月至2017年11月在作者所在医院接受TAVR的连续性患者。在1个月、6个月、12个月和此后每年对患者进行随访。根据第三版心肌梗死通用定义对ACS进行诊断和分类。

共纳入779名患者(平均年龄79±9岁,52%为男性,平均STS:6.8±5.1%),其中68%有CAD病史。中位随访25个月(四分位间距:10至44),78名患者(10%)出现至少1次ACS发作,其中一半事件发生在TAVR后1年内。临床表现为2型非ST段抬高型心梗(35.9%)、不稳定型心绞痛(34.6%)、1型非ST段抬高型心梗(28.2%)和ST段抬高型心肌梗死(1.3%)。男性(风险比[HR]:2.19; 95%置信区间[CI]:1.36至3.54; p=0.001)、既往患CAD(HR:2.78; 95%CI:1.50至5.18; p=0.001)和非经股动脉通路(HR:1.71; 95%CI:1.04至2.75; p=0.035)与ACS独立相关。53名ACS患者(67.9%)进行了冠脉造影,其中30名患者(56.6%)接受了经皮冠脉介入治疗。ACS发作时的院内死亡率为3.8%。ACS后中位随访21个月(四分位间距:8至34个月),全因和心血管死亡率分别为37.3%和25.3%

中位随访25个月后,约十分之一接受TAVR的患者因ACS再次入院。男性、既往患CAD和非经股动脉通路是ACS的独立预测因子。ACS与中期死亡率高相关。

原始出处:

Victoria Vilalta. Incidence, Clinical Characteristics, and Impact of Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement. JACC:Cardiovascular Interventions. December 2018.

本文系梅斯医学(MedSci)原创编译整理,转载需授权!

 

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    2019-01-04 hbwxf
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    2019-01-21 yxch48
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  5. 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  6. 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  7. 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    2018-12-20 lsj631

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虚弱患者接受更具侵入性的非股动脉通路TAVR后的30天死亡率风险明显升高。而无论通路如何,非虚弱老年人都能耐受TAVR,并且短期风险低。

JAMA Cardiol:医院外科主动脉瓣置换质量与TAVR后30天和1年死亡率的关联

SAVR死亡率较高的医院在开展TAVR项目后,TAVR的长短期死亡率也较高。

Circ: Cardiovascular Interventions:经导管主动脉瓣置换术中经颈动脉与其他替代通路的比较

经颈动脉血管通路的TAVR安全可行,并与令人满意的短期临床结局相关。

JACC: CoreValve研究——高危患者TAVR或SAVR术后5年结局竟相似

近日,JACC发表了CoreValve美国核心高风险试验5年随访结果,这是第一项在手术高死亡风险患者中显示,经导管主动脉瓣置换术(TAVR)与外科主动脉瓣置换术(SAVR)相比,具有1年死亡率优势的随机试验。

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