Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland.
Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland.
Int J Cardiol. 2017 Sep 15;243:150-155. doi: 10.1016/j.ijcard.2017.05.071. Epub 2017 May 17.
The prognostic role of concomitant coronary artery disease (CAD) among patients undergoing transcatheter aortic valve implantation (TAVI) is still uncertain.
Data from the Bern TAVI Registry and the Bern PCI Registry were analyzed. Patients with concomitant CAD undergoing TAVI (TAVI+CAD) were age- and gender-matched to the following two cohorts: patients without CAD undergoing TAVI (TAVI-noCAD) and patients with stable CAD undergoing percutaneous coronary intervention (CAD-noAS). Major adverse cardiovascular and cerebrovascular events (MACCE), defined as the composite of cardiovascular death, myocardial infarction, or cerebrovascular events, represented the primary endpoint at 1-year.
Out of 9478 procedures performed between 2007 and 2013 (807 TAVI; 8671 PCI), three cohorts, each including 248 subjects, were derived. At 1-year, MACCE were significantly increased among TAVI+CAD compared with TAVI-noCAD (16.8% vs. 9.8%, hazard ratio, HR, 1.75, 95% confidence intervals, CI, 1.06-2.89, p=0.030) and CAD-noAS patients (16.8% vs. 9.5%, HR 1.85, 95%CI 1.11-3.09, p=0.018) whereas no difference was found between TAVI-noCAD and CAD-noAS patients. The higher rate of MACCE among TAVI+CAD patients was mainly driven by an increased risk of cardiovascular mortality compared with the TAVI-noCAD (HR 1.86, 95%CI 1.03-3.36, p=0.040) and CAD-noAS cohorts (HR 2.29, 95%CI 1.22-4.30, p=0.010). The 1-year rate of MACCE was similar between TAVI-noCAD and CAD-noAS patients (9.8% vs. 9.5%, HR 1.05, 95%CI 0.59-1.87, p=0.86).
Concomitant CAD in the setting of TAVI conveyed an increased risk of ischemic events and cardiovascular mortality at 1-year follow-up.
在接受经导管主动脉瓣置换术（TAVI）的患者中，同时存在冠状动脉疾病（CAD）的预后作用仍不确定。
分析了伯尔尼 TAVI 注册中心和伯尔尼 PCI 注册中心的数据。接受 TAVI 治疗的同时存在 CAD（TAVI+CAD）的患者按年龄和性别与以下两个队列相匹配：未患 CAD 接受 TAVI 治疗的患者（TAVI-noCAD）和接受经皮冠状动脉介入治疗（CAD-noAS）的稳定 CAD 患者。主要不良心血管和脑血管事件（MACCE）定义为心血管死亡、心肌梗死或脑血管事件的复合终点，在 1 年时为主要终点。
在 2007 年至 2013 年间进行的 9478 例手术中（807 例 TAVI；8671 例 PCI），衍生出了三个队列，每个队列包括 248 例患者。在 1 年时，与 TAVI-noCAD 患者（16.8%比 9.8%，危险比，HR，1.75，95%置信区间，CI，1.06-2.89，p=0.030）和 CAD-noAS 患者（16.8%比 9.5%，HR 1.85，95%CI 1.11-3.09，p=0.018）相比，TAVI+CAD 患者的 MACCE 发生率显著增加，而 TAVI-noCAD 患者和 CAD-noAS 患者之间无差异。TAVI+CAD 患者 MACCE 发生率较高主要是由于与 TAVI-noCAD 患者（HR 1.86，95%CI 1.03-3.36，p=0.040）和 CAD-noAS 队列（HR 2.29，95%CI 1.22-4.30，p=0.010）相比，心血管死亡率的风险增加所致。TAVI-noCAD 和 CAD-noAS 患者的 1 年 MACCE 发生率相似（9.8%比 9.5%，HR 1.05，95%CI 0.59-1.87，p=0.86）。
在 TAVI 治疗中同时存在 CAD 会增加 1 年时缺血事件和心血管死亡率的风险。
