经皮二尖瓣球囊成形术后的精算随访。发病率及事件预测因素

Hernández García J M, Castillo Castro J L, Alonso Briales J H, Alvarez de Cienfuegos Rivera F, Bullones Ramírez J, Alvarez Rubiera J, Rubio Alcaide A, Gómez Doblas J J, de Mora Martín M, Zafra Sánchez J, Urda Valcárcel T, Conejo Muñoz L, Malpartida de Torres F

Servicio de Cardiología, Hospital Regional Carlos Haya, Málaga.

Rev Esp Cardiol. 1999 Jul;52(7):503-11.

INTRODUCTION

The goal of this study is to analyse the follow-up of patients who underwent percutaneous mitral valvuloplasty and the predicting factors of event-free survival.

METHODS

We analysed 220 consecutive valvuloplasty performed between 1988 and 1996 in order to establish the incidence of events (death, restenosis, mitral valve surgery, New York Heart Association class IV, new valvuloplasty or systemic embolia) and the baseline and postprocedural characteristics predicting events, during a mean follow-up of 42 months (range 1-96 months).

RESULTS

Overall survival was 94.7%, and event-free survival was 59.2% at 96 months. We analyzed the baseline characteristics in order to predict the mid-term outcome (actuarial survival Kaplan-Meier method) that atrial fibrillation (p < 0.01), age > or = 56 years (p < 0.005), and echocardiographic score > or = 9 (p < 0.005) were baseline characteristics related to adverse events in follow up. An index based on the number of adverse factors in the baseline characteristics provided a significant difference in concerning the number of follow up to even-free between the group without baseline adverse characteristics and the group with two (p = 0.008, OR = 4.5), or three adverse characteristics (p = 0.005, OR 6.4). Among the postprocedural characteristics, while patients with mitral valve area after valvuloplasty > or = 1.5 cm2 had an event-free survival of 72.9% at 96 months, those with postprocedural mitral valve area < 1.5 cm2 had an event-free survival of 10.5% (log-rank test p < 0.0001).

CONCLUSIONS

Mid-term event-free survival after percutaneous mitral balloon valvuloplasty can be predicted by baseline and postprocedural characteristics. Age > or = 56, echocardiographic score > or = 9 and atrial fibrillation are baseline factors related with adverse events. Patients with 0 or 1 baseline adverse factors do not have significant differences concerning mid-term outcome while, those with 2, and above all, 3 adverse baseline characteristics have a poorer event-free survival. Mitral valve area > or = 1.5 cm2 is the only postprocedural independent predictor of event-free survival.

引言

本研究的目的是分析接受经皮二尖瓣球囊成形术患者的随访情况以及无事件生存期的预测因素。

方法

我们分析了1988年至1996年间连续进行的220例瓣膜成形术，以确定事件（死亡、再狭窄、二尖瓣手术、纽约心脏协会IV级、再次瓣膜成形术或系统性栓塞）的发生率以及预测事件的基线和术后特征，平均随访时间为42个月（范围1 - 96个月）。

结果

总体生存率为94.7%，96个月时无事件生存率为59.2%。我们分析了基线特征以预测中期结果（精算生存Kaplan - Meier方法），即房颤（p < 0.01）、年龄≥56岁（p < 0.005）和超声心动图评分≥9（p < 0.005）是随访中与不良事件相关的基线特征。基于基线特征中不良因素数量的一个指数显示，在无基线不良特征组与有两个（p = 0.008，OR = 4.5）或三个不良特征组之间，无事件随访数量存在显著差异。在术后特征中，瓣膜成形术后二尖瓣瓣口面积≥1.5 cm²的患者96个月时无事件生存率为72.9%，而术后二尖瓣瓣口面积< 1.5 cm²的患者无事件生存率为10.5%（对数秩检验p < 0.0001）。

结论

经皮二尖瓣球囊成形术后的中期无事件生存期可通过基线和术后特征进行预测。年龄≥56岁、超声心动图评分≥9和房颤是与不良事件相关的基线因素。无或有1个基线不良因素的患者在中期结果方面无显著差异，而有2个，尤其是3个不良基线特征的患者无事件生存期较差。二尖瓣瓣口面积≥1.5 cm²是术后无事件生存期唯一的独立预测因素。