Bhatia Nirmanmoh, Agrawal Sahil, Yang Sushan, Yadav Kapil, Agarwal Manyoo, Garg Lohit, Agarwal Nayan, Shirani Jamshid, Fredi Joseph L
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania.
Am J Cardiol. 2017 Oct 15;120(8):1355-1358. doi: 10.1016/j.amjcard.2017.07.022. Epub 2017 Jul 25.
The outcomes of patients with end-stage renal disease on dialysis (chronic kidney disease stage 5 on dialysis [CKD 5D]) who undergo transcatheter aortic valve implantation (TAVI) are not well described due to the exclusion of this group in randomized trials. We analyzed the National Inpatient Sample database and compared clinical characteristics and in-hospital outcomes for patients with CKD 5D versus those without CKD 5D (nondialysis group) who underwent TAVI in 2011 to 2014 in the United States. The study population included 1,708 patients (4%) with CKD 5D and 40,481 patients (96%) without CKD 5D who underwent TAVI. Patients with CKD 5D were younger (75.3 ± 9.9 vs 81.4 ± 8.4 years, p <0.001), more likely to be men (62.8% vs 52%, p <0.001), and less likely to be Caucasian (73.6% vs 87.8%, p <0.001). Patients with CKD 5D were more likely to have congestive heart failure (16% vs 11.7%, p <0.001), diabetes with chronic complications (19% vs 5.4%, p <0.001), hypertension (86.5% vs 79.3%, p <0.001), and peripheral vascular disease (34.5% vs 29.4%, p <0.001), but were less likely to have atrial fibrillation (38.6% vs 44.8%, p <0.001) and chronic pulmonary disease (27.5% vs 33.6%, p <0.001). In-hospital mortality was significantly higher in the dialysis group (8.2% vs 4%; adjusted odds ratio 2.21, 95% confidence interval1.81 to 2.69, p <0.001) after adjusting for age, gender, co-morbidities, and hospital characteristics in a robust multivariate regression model. In conclusion, patients with CKD 5D who undergo TAVI have a higher in-hospital mortality than those without CKD 5D.
由于随机试验将终末期肾病透析患者（慢性肾脏病5期透析患者[CKD 5D]）排除在外，其接受经导管主动脉瓣植入术（TAVI）的预后情况尚无详尽描述。我们分析了美国国家住院样本数据库，比较了2011年至2014年接受TAVI的CKD 5D患者与非CKD 5D患者（非透析组）的临床特征和住院结局。研究人群包括1708例（4%）CKD 5D患者和40481例（96%）非CKD 5D患者，他们均接受了TAVI。CKD 5D患者更年轻（75.3±9.9岁 vs 81.4±8.4岁，p<0.001），男性比例更高（62.8% vs 52%，p<0.001），白种人比例更低（73.6% vs 87.8%，p<0.001）。CKD 5D患者更易发生充血性心力衰竭（16% vs 11.7%，p<0.001）、伴有慢性并发症的糖尿病（19% vs 5.4%，p<0.001）、高血压（86.5% vs 79.3%，p<0.001）和外周血管疾病（34.5% vs 29.4%，p<0.001），但发生心房颤动（38.6% vs 44.8%，p<0.001）和慢性肺病（27.5% vs 33.6%，p<0.001）的可能性较小。在一个稳健的多变量回归模型中，对年龄、性别、合并症和医院特征进行校正后，透析组的住院死亡率显著更高（8.2% vs 4%；校正优势比2.21，95%置信区间1.81至2.69，p<0.001）。总之，接受TAVI的CKD 5D患者的住院死亡率高于非CKD 5D患者。
