Washington University School of Medicine, St. Louis, Missouri.
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
J Am Coll Cardiol. 2014 Mar 25;63(11):1090-9. doi: 10.1016/j.jacc.2013.10.057. Epub 2013 Nov 27.
The goal of this study was to determine whether a less-invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS).
Diabetes is associated with increased morbidity and mortality after surgical AVR for AS.
Among treated patients with severe symptomatic AS at high risk for surgery in the PARTNER (Placement of Aortic Transcatheter Valve) trial, we examined outcomes stratified according to diabetes status of patients randomly assigned to receive transcatheter or surgical AVR. The primary outcome was all-cause mortality at 1 year.
Among 657 patients enrolled in PARTNER who underwent treatment, there were 275 patients with diabetes (145 transcatheter, 130 surgical). There was a significant interaction between diabetes and treatment group for 1-year all-cause mortality (p = 0.048). Among diabetic patients, all-cause mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the surgical group (hazard ratio: 0.60 [95% confidence interval: 0.36 to 0.99]; p = 0.04). Results were consistent among patients treated via transfemoral or transapical routes. In contrast, among nondiabetic patients, there was no significant difference in all-cause mortality at 1 year (p = 0.48). Among diabetic patients, the 1-year rates of stroke were similar between treatment groups (3.5% transcatheter vs. 3.5% surgery; p = 0.88), but the rate of renal failure requiring dialysis >30 days was lower in the transcatheter group (0% vs. 6.1%; p = 0.003).
Among patients with diabetes and severe symptomatic AS at high risk for surgery, this post-hoc stratified analysis of the PARTNER trial suggests there is a survival benefit, no increase in stroke, and less renal failure from treatment with transcatheter AVR compared with surgical AVR. (The PARTNER Trial: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
本研究旨在探讨经导管主动脉瓣置换术（AVR）在治疗合并糖尿病的主动脉瓣狭窄（AS）患者中的作用。
对于接受外科主动脉瓣置换术（SAVR）治疗的合并糖尿病的 AS 患者，糖尿病与手术死亡率的增加有关。
在 PARTNER 试验（经导管主动脉瓣置换术治疗高危严重症状性 AS 患者）中，我们对随机接受经导管或外科 AVR 治疗的高危手术 AS 患者的临床结局进行了亚组分析。主要终点为 1 年全因死亡率。
在 PARTNER 试验中，共纳入 657 例接受治疗的患者，其中 275 例（145 例经导管，130 例外科）患有糖尿病。糖尿病和治疗方式对 1 年全因死亡率有显著的交互作用（p = 0.048）。在糖尿病患者中，经导管组 1 年全因死亡率为 18.0%，外科组为 27.4%（风险比：0.60[95%置信区间：0.36 至 0.99]；p = 0.04）。经股动脉或经心尖途径治疗的患者结果一致。相比之下，在非糖尿病患者中，1 年全因死亡率无显著差异（p = 0.48）。在糖尿病患者中，两组之间的 1 年卒中发生率相似（经导管组为 3.5%，外科组为 3.5%；p = 0.88），但经导管组的肾衰竭发生率（需透析治疗>30 天）较低（0% vs. 6.1%；p = 0.003）。
在患有糖尿病且手术风险高的严重症状性 AS 患者中，PARTNER 试验的这项事后分层分析表明，与外科 AVR 相比，经导管 AVR 治疗具有生存获益，卒中发生率无增加，且肾衰竭发生率降低。（PARTNER 试验：经导管主动脉瓣置换术治疗高危严重症状性主动脉瓣狭窄患者；NCT00530894）
