Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Int J Cardiol. 2017 Oct 1;244:93-99. doi: 10.1016/j.ijcard.2017.06.024. Epub 2017 Jun 13.
Anemia is frequent in patients undergoing transcatheter aortic valve implantation (TAVI) with a strong negative prognostic impact. The prevalence and prognosis of anemia and separately of iron-deficiency anemia in contemporary patients are unclear.
In total, 549 consecutive patients undergoing transfemoral TAVI were included in the single-center study. Baseline anemia was defined as a hemoglobin level <13g/dL in men and <12g/dL in women. In an unselected subgroup of anemic patients (n=115), a complete iron status was obtained and anemia was classified as iron-deficiency versus non-iron-deficiency. The primary endpoint was death or re-hospitalization for worsening heart failure within one year after TAVI. Anemia was present in 45% (249/549) of the population and was significantly associated with a higher rate of the primary endpoint (25% (63/249) vs. 8% (25/300); p<0.001). In a multivariable model adjusted for variables associated with the primary endpoint, baseline anemia was an independent predictor of the primary endpoint (hazard ratio 2.81, 95% confidence interval [1.69-4.67]; p<0.001). Iron-deficiency anemia was present in 79% (91/115) of the subgroup and the rate of the primary endpoint was comparable to non-iron-deficiency anemia (31% (28/91) vs. 21% (5/24); p=0.338).
In contemporary TAVI patients, anemia remains a common comorbidity and independently predicts adverse outcome. In an unselected subgroup of anemic patients, iron-deficiency was common and had similar clinical outcome compared to non-iron-deficiency. Whether correction of iron-deficiency anemia impacts prognosis remains to be investigated.
在接受经导管主动脉瓣植入术（TAVI）的患者中，贫血很常见，且具有强烈的负面预后影响。目前尚不清楚当代患者贫血和缺铁性贫血的患病率和预后。
本研究共纳入 549 例连续接受经股动脉 TAVI 的患者。基线贫血定义为男性血红蛋白水平<13g/dL，女性<12g/dL。在一组未选择的贫血患者亚组（n=115）中，获得了完整的铁状态，并将贫血分为缺铁性和非缺铁性。主要终点是 TAVI 后 1 年内死亡或因心力衰竭恶化再次住院。该人群中 45%（249/549）存在贫血，且与较高的主要终点发生率显著相关（25%（63/249）vs. 8%（25/300）；p<0.001）。在调整与主要终点相关的变量的多变量模型中，基线贫血是主要终点的独立预测因素（危险比 2.81，95%置信区间[1.69-4.67]；p<0.001）。亚组中 79%（91/115）存在缺铁性贫血，主要终点发生率与非缺铁性贫血相当（31%（28/91）vs. 21%（5/24）；p=0.338）。
在当代 TAVI 患者中，贫血仍然是一种常见的合并症，并独立预测不良结局。在一组未选择的贫血患者亚组中，缺铁性贫血很常见，与非缺铁性贫血相比，其临床结局相似。纠正缺铁性贫血是否会影响预后仍有待研究。
