Hernández-Enríquez Marco, Regueiro Ander, Romaguera Rafael, Andrea Rut, Gómez-Hospital Joan Antoni, Pujol-López Margarida, Ferreiro-Gutiérrez José Luis, Brugaletta Salvatore, Roura Gerard, Freixa Xavier, Gómez-Lara Josep, Martín-Yuste Victoria, Gracida Montserrat, Cequier Ángel, Sabaté Manel
Cardiology Department, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Cardiology Department, Hospital Universitari Bellvitge, Barcelona, Spain.
Catheter Cardiovasc Interv. 2019 Jun 1;93(7):1344-1351. doi: 10.1002/ccd.27907. Epub 2018 Sep 23.
Thrombocytopenia after transcatheter aortic valve implantation (TAVI) is common and has been related to higher mortality and major complications. No comparison between balloon-expandable (BEV) and self-expanding valves (SEV) regarding drop platelet count (DPC) has been reported to date. The objectives of this study were to analyze the differences in DPC between BEVs or SEVs and their prognostic implications in clinical outcomes.
We retrospectively analyzed patients undergoing TAVI. Platelet counts after TAVI were collected. Two groups were created: DPC ≤ 30% and DPC > 30%. VARC-2 criteria were used to define outcomes.
Study population was composed of 195 patients (age 77.5 ± 6.7, 57.4% males). All of them but one experienced DPC (mean DPC 31.9 ± 15.3%). DPC was significantly higher among the patients treated with BEV compared to those treated with SEV (36.3 ± 15.1% vs 27.7 ± 14.4, P < 0.001). After multivariate analysis, the use of BEV was independently associated with a higher rate of DPC > 30% (67.4% vs 36.0%; OR 3.4; 95% CI, 1.42-8.16). At 30 days, the DPC > 30% was associated with a higher rate of life-threatening/major bleeding, major vascular complications, in-hospital sepsis and mortality. At one year, there were no statistically significant differences in the mortality rate between groups (6.35% vs 10.0%, HR 1.54; 95% CI, 0.56-4.25).
In this study, the use of BEV was associated with a higher risk of DPC after TAVI. A DPC rate > 30% was associated with an increased risk of major complications at 30 days.
经导管主动脉瓣植入术（TAVI）后血小板减少症很常见，且与较高的死亡率和主要并发症相关。迄今为止，尚未有关于球囊扩张式瓣膜（BEV）和自膨胀式瓣膜（SEV）在血小板计数下降（DPC）方面的比较报道。本研究的目的是分析BEV或SEV之间DPC的差异及其对临床结局的预后影响。
我们回顾性分析了接受TAVI的患者。收集了TAVI后的血小板计数。分为两组：DPC≤30%和DPC>30%。采用VARC-2标准定义结局。
研究人群包括195例患者（年龄77.5±6.7岁，男性占57.4%）。除1例患者外，所有患者均出现DPC（平均DPC 31.9±15.3%）。与接受SEV治疗的患者相比，接受BEV治疗的患者DPC显著更高（36.3± 15.1%对27.7±14.4%，P<0.001）。多因素分析后，使用BEV与DPC>30%的发生率较高独立相关（67.4%对36. 0%；OR 3.4；95%CI，1.42-8.16）。在30天时，DPC>30%与危及生命/大出血、主要血管并发症、院内感染和死亡率的发生率较高相关。在1年时，两组之间的死亡率无统计学显著差异（6.35%对10.0%，HR 1.54；95%CI，0.56-4.25）。
在本研究中，使用BEV与TAVI后DPC风险较高相关联。DPC率>30%与30天时主要并发症风险增加相关。
