SURTAVI 试验中严重主动脉瓣狭窄且 STS PROM 小于 3%的患者的一年结果。

One-year outcomes of patients with severe aortic stenosis and an STS PROM of less than three percent in the SURTAVI trial.

机构信息

International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom.

出版信息

EuroIntervention. 2018 Oct 20;14(8):877-883. doi: 10.4244/EIJ-D-18-00460.

DOI:10.4244/EIJ-D-18-00460

PMID:29992904

Abstract

AIMS

The indication for transcatheter aortic valve implantation (TAVI) has evolved from inoperable patients to patients at increased surgical risk. In low-risk patients, surgical aortic valve replacement (SAVR) remains the standard of care. The aim of this study was to explore the outcomes of TAVI and SAVR in patients with a Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score below 3% in the SURTAVI trial.

METHODS AND RESULTS

In SURTAVI, patients at intermediate surgical risk based on Heart Team consensus were randomised to TAVI or SAVR. We stratified the overall patient population into quintiles based on the STS PROM score; the one-year mortality was correlated with the mean STS PROM score in each quintile. The quintiles were regrouped into three clinically relevant categories of STS score: less than 3%, 3 to <5%, and >5%. All-cause mortality or disabling stroke in each risk stratum was compared between TAVI and SAVR. Linear regressions between mean values of STS PROM in each quintile and observed all-cause mortality at one year showed great association for the global population (r2=0.92), TAVI (r2=0.89) and SAVR cohorts (r2=0.73). All-cause mortality or disabling stroke of TAVI vs. SAVR was 1.5% vs. 6.5% (p=0.04), 6.5% vs. 7.6% (p=0.52) and 13.5% vs. 11.0% (p=0.40) in the <3%, 3-5%, and ≥5% STS score strata, respectively.

CONCLUSIONS

Among patients at intermediate surgical risk but with an STS PROM <3%, TAVI may achieve superior clinical outcomes compared to SAVR. These findings support the need for an adequately powered randomised trial to compare TAVI with SAVR in patients at low operative risk.

摘要

目的

经导管主动脉瓣置换术（TAVI）的适应证已从不能手术的患者扩展到手术风险增加的患者。在低危患者中，外科主动脉瓣置换术（SAVR）仍是标准治疗方法。本研究旨在探讨在 SURTAVI 试验中，STS 预测死亡率（PROM）评分低于 3%的患者中，TAVI 和 SAVR 的结果。

方法和结果

在 SURTAVI 中，根据心脏团队共识，中危手术风险的患者被随机分配至 TAVI 或 SAVR 组。我们根据 STS PROM 评分将整个患者人群分为五组；根据每个五分位组的平均 STS PROM 评分来关联一年死亡率。将五分位组重新分为 STS 评分三个具有临床意义的类别：<3%、3-<5%和>5%。比较每个风险分层中 TAVI 和 SAVR 的全因死亡率或致残性卒中。在每个五分位组中 STS PROM 平均值与一年观察到的全因死亡率之间的线性回归显示，对于整个人群（r2=0.92）、TAVI（r2=0.89）和 SAVR 队列（r2=0.73）都有很好的相关性。TAVI 与 SAVR 的全因死亡率或致残性卒中分别为 1.5%比 6.5%（p=0.04）、6.5%比 7.6%（p=0.52）和 13.5%比 11.0%（p=0.40），在 STS 评分<3%、3-5%和≥5%的分层中。