重度主动脉瓣狭窄患者经导管主动脉瓣置换术后出院时B型利钠肽升高与2年死亡率相关：来自多中心前瞻性OCEAN-TAVI（优化经导管瓣膜干预-经导管主动脉瓣植入）注册研究的见解
Elevation of B-Type Natriuretic Peptide at Discharge is Associated With 2-Year Mortality After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis: Insights From a Multicenter Prospective OCEAN-TAVI (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation) Registry.
作者信息
Mizutani Kazuki, Hara Masahiko, Iwata Shinichi, Murakami Takashi, Shibata Toshihiko, Yoshiyama Minoru, Naganuma Toru, Yamanaka Futoshi, Higashimori Akihiro, Tada Norio, Takagi Kensuke, Araki Motoharu, Ueno Hiroshi, Tabata Minoru, Shirai Shinichi, Watanabe Yusuke, Yamamoto Masanori, Hayashida Kentaro
机构信息
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
出版信息
J Am Heart Assoc. 2017 Jul 14;6(7):e006112. doi: 10.1161/JAHA.117.006112.
BACKGROUND
In this study, we sought to investigate the 2-year prognostic impact of B-type natriuretic peptide (BNP) levels at discharge, following transcatheter aortic valve replacement.
METHODS AND RESULTS
We enrolled 1094 consecutive patients who underwent transcatheter aortic valve replacement between 2013 and 2016. Study patients were stratified into 2 groups according to survival classification and regression tree analysis (high versus low BNP groups). We evaluated the impact of high BNP on 2-year mortality compared with that of low BNP using a multivariable Cox model, and assessed whether this stratification would improve predictive accuracy for determining 2-year mortality by assessing time-dependent net reclassification improvement and integrated discrimination improvement. The median age of patients was 85 years (quartile 82-88), and 29.2% of the study population were men. The median Society of Thoracic Surgeons score was 6.8 (4.7-9.5), and BNP at discharge was 186 (93-378) pg/mL. All-cause mortality following discharge was 7.9% (95% CI, 5.8-9.9%) at 1 year and 15.4% (95% CI, 11.6-19.0%) at 2 years. The survival classification and regression tree analysis revealed that the discriminating BNP level to discern 2-year mortality was 202 pg/mL, and that elevated BNP had a statistically significant impact on outcomes, with an adjusted hazard ratio of 2.28 (1.36-3.82, =0.002). The time-dependent net reclassification improvement (=0.047) and integrated discrimination improvement (=0.029) analysis revealed that the incorporation of BNP stratification with other clinical variables significantly improved predictive accuracy for 2-year mortality.
CONCLUSIONS
Elevation of BNP at discharge is associated with 2-year mortality after transcatheter aortic valve replacement.
背景
在本研究中，我们试图探讨经导管主动脉瓣置换术后出院时B型利钠肽（BNP）水平对2年预后的影响。
方法与结果
我们纳入了2013年至2016年间连续接受经导管主动脉瓣置换术的1094例患者。根据生存分类和回归树分析，将研究患者分为两组（高BNP组与低BNP组）。我们使用多变量Cox模型评估高BNP与低BNP相比对2年死亡率的影响，并通过评估时间依赖性净重新分类改善和综合辨别改善来评估这种分层是否会提高确定2年死亡率的预测准确性。患者的中位年龄为85岁（四分位数82 - 88），研究人群中29.2%为男性。胸外科医师协会评分的中位数为6.8（4.7 - 9.5），出院时BNP为186（93 - 378）pg/mL。出院后的全因死亡率在1年时为7.9%（95%CI，5.8 - 9.9%），在2年时为15.4%（95%CI，11.6 - 19.0%）。生存分类和回归树分析显示，辨别2年死亡率的BNP区分水平为202 pg/mL，BNP升高对结局有统计学显著影响，调整后的风险比为2.28（1.36 - 3.82，P = 0.002）。时间依赖性净重新分类改善（P = 0.047）和综合辨别改善（P = 0.029）分析显示，将BNP分层与其他临床变量相结合可显著提高2年死亡率的预测准确性。
结论
经导管主动脉瓣置换术后出院时BNP升高与2年死亡率相关。
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