Mangner Norman, Woitek Felix J, Haussig Stephan, Holzhey David, Stachel Georg, Schlotter Florian, Höllriegel Robert, Mohr Friedrich W, Schuler Gerhard, Linke Axel
Department of Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany.
Department of Cardiac Surgery, Heart Center Leipzig-University Hospital, Leipzig, Germany.
J Interv Cardiol. 2018 Apr;31(2):188-196. doi: 10.1111/joic.12458. Epub 2017 Nov 22.
Patients undergoing transcatheter aortic valve replacement (TAVR) are often characterized by risk factors not reflected in conventional risk scores. In this context, little is known about the outcome of patients suffering from an active cancer disease (ACD). The objective was to determine the prevalence, clinical characteristics, perioperative outcomes, and mortality of patients with ACD undergoing TAVR compared to those with a history of cancer (HCD) and controls without known tumor disease.
TAVR patients between 02/2006 and 09/2014 were stratified according to the presence of ACD, HCD, and control. All-cause-mortality at 1-year was the primary end point. All end point definitions were subject to the Valve Academic Research Consortium II definitions.
Overall, 1821 patients were included: 99 patients (5.4%) suffered from ACD and 251 patients (13.8%) had HCD. ACD was related to a solid organ or hematological source in 72.7% and 27.3%, respectively. Patients with ACD were more often male (P = 0.004) and had a lower logisticEuroScore I (P = 0.033). Overall rates of VARC-II defined periprocedural myocardial infarction, stroke, bleeding, access-site complications, and acute kidney injury were not different between groups. Thirty-day mortality did not differ between patients with ACD, HCD, and controls (6.1% vs 4.4% vs 7.6%, P = 0.176). All-cause 1-year mortality was higher in patients with ACD compared HCD and controls (37.4% vs 16.4% vs 20.8%, P < 0.001). ACD was an independent predictor of all-cause 1-year mortality (HR 2.10, 95%-CI 1.41-3.13, P < 0.001).
The presence of ACD in patients undergoing TAVR is associated with significantly higher 1-year mortality.
接受经导管主动脉瓣置换术（TAVR）的患者通常具有传统风险评分未反映出的风险因素。在此背景下，对于患有活动性癌症疾病（ACD）的患者的预后知之甚少。目的是确定与有癌症病史（HCD）的患者和无已知肿瘤疾病的对照组相比，接受TAVR的ACD患者的患病率、临床特征、围手术期结局和死亡率。
将2006年2月至2014年9月期间的TAVR患者根据是否存在ACD、HCD和对照组进行分层。1年时的全因死亡率是主要终点。所有终点定义均符合瓣膜学术研究联盟II的定义。
总体而言，共纳入1821例患者：99例（5.4%）患有ACD，251例（13.8%）有HCD。ACD分别与实体器官或血液系统来源相关，比例分别为72.7%和27.3%。ACD患者男性更为常见（P = 0.004），且逻辑欧洲心脏手术风险评估系统I较低（P = 0.033）。VARC-II定义的围手术期心肌梗死、中风、出血、穿刺部位并发症和急性肾损伤的总体发生率在各组之间无差异。ACD患者、HCD患者和对照组的30天死亡率无差异（6.1%对4.4%对7.6%，P = 0.176）。与HCD患者和对照组相比,ACD患者的全因1年死亡率更高（37.4%对16.4%对20.8%，P < 0.001）。ACD是全因1年死亡率的独立预测因素（HR 2.10，95%置信区间1.41 - 3.13，P < 0.001）。
接受TAVR的患者中存在ACD与1年死亡率显著升高相关。
