Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Am J Cardiol. 2019 Jan 15;123(2):306-314. doi: 10.1016/j.amjcard.2018.09.042. Epub 2018 Oct 22.
To establish evidence whether baseline anemia and decreases in baseline hemoglobin levels affect survival after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of available studies. Studies considered for inclusion met the following criteria: the design was a comparative study of patients with baseline anemia versus those without baseline anemia or a cohort study investigating baseline anemia (as a dichotomous variable) or baseline hemoglobin levels (as a continuous variable) as one of prognostic factors of mortality; the study population was patients who underwent TAVI; and main outcomes included early (30-day or in-hospital) or late (including early) all-cause mortality. Study-specific estimates were combined in the random-effects model. Our search identified 15 eligible studies including a total of 11,657 TAVI patients. Pooled analysis demonstrated that baseline anemia was associated with a statistically significant increase in early (p = 0.003) and midterm mortality (p < 0.0001) and that incremental decreases in baseline hemoglobin levels were associated with a statistically significant increase in midterm mortality (p < 0.00001). Pooled analysis of only adjusted estimates indicated that anemia was independently associated with a statistically significant increase in early (p = 0.02) and midterm mortality (p < 0.0001) and that incremental decreases in baseline hemoglobin levels were independently associated with a statistically significant increase in midterm mortality (p < 0.00001). In conclusion, baseline anemia and lower baseline hemoglobin levels may be associated with increased early and midterm mortality after TAVI.
为了确定基线贫血和血红蛋白水平下降是否影响经导管主动脉瓣置换术（TAVI）后的生存，我们对现有研究进行了荟萃分析。考虑纳入的研究符合以下标准：设计为基线贫血患者与无基线贫血患者的比较研究，或队列研究调查基线贫血（作为二分类变量）或基线血红蛋白水平（作为连续变量）作为死亡率的一个预后因素；研究人群为接受 TAVI 的患者；主要结局包括早期（30 天或住院期间）或晚期（包括早期）全因死亡率。采用随机效应模型对研究特异性估计值进行合并。我们的搜索确定了 15 项符合条件的研究，共包括 11657 例 TAVI 患者。汇总分析表明，基线贫血与早期（p=0.003）和中期死亡率（p<0.0001）显著增加相关，基线血红蛋白水平的逐渐下降与中期死亡率显著增加相关（p<0.00001）。仅对调整后的估计值进行的汇总分析表明，贫血与早期（p=0.02）和中期死亡率（p<0.0001）显著增加独立相关，基线血红蛋白水平的逐渐下降与中期死亡率显著增加独立相关（p<0.00001）。总之，基线贫血和较低的基线血红蛋白水平可能与 TAVI 后早期和中期死亡率增加有关。
