Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Interventional Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Catheter Cardiovasc Interv. 2019 Nov 15;94(6):795-805. doi: 10.1002/ccd.28175. Epub 2019 Mar 22.
To explore the prevalence of smoking, and its association with clinical and mortality outcome among patients undergoing transcatheter aortic valve replacement (TAVR).
Less data exist regarding the effect of baseline smoking status on clinical and mortality outcome among patients undergoing TAVR.
Consecutive patients who underwent TAVR at two high volume Dutch centers were included. Smoking status was prospectively questioned by a structured interview at admission. Primary endpoint was 1-year all-cause mortality after TAVR.
A total of 913 consecutive patients (80.1 ± 7.6 years; logistic EuroSCORE: 16.5 ± 9.9%) who underwent TAVR for severe aortic valve stenosis were included. There were 47% (n = 432) males, and 57% (n = 522) never-smokers, and 35% (n = 317) prior-smokers, and 8% (n = 74) current-smokers. Smokers (i.e., prior-smokers or current-smokers) were younger compared to never-smokers (78.9 ± 7.9 and 76.4 ± 8.0 vs. 81.3 ± 7.1, P < 0.000, respectively). Median follow-up time was 365 (interquartile range [IQR]: 280-365) days. Overall, prior-smoking was not associated with all-cause mortality at 1-year following TAVR (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.55-1.23). After stratification according to sex, male prior-smokers showed better 1-year survival after TAVR than male never-smokers (12% vs. 20%; P = 0.018, respectively, HR 0.52, 95% CI 0.29-0.89), while this reversed effect was not observed among female prior-smokers versus female never-smokers after TAVR (HR 1.70, 95% CI 0.95-3.05).
Overall, baseline prior-smokers had similar 1-year mortality outcome after TAVR compared with baseline never-smokers. However, there was a reversed association between baseline prior-smoking status and 1-year mortality after TAVR among males, which could partially be explained due to the favorable baseline characteristics.
探讨经导管主动脉瓣置换术（TAVR）患者吸烟的流行情况及其与临床和死亡率结局的关系。
关于 TAVR 患者基线吸烟状况对临床和死亡率结局的影响，数据较少。
连续纳入在荷兰两家高容量中心接受 TAVR 的患者。在入院时通过结构化访谈前瞻性询问吸烟状况。主要终点是 TAVR 后 1 年的全因死亡率。
共纳入 913 例连续接受 TAVR 治疗严重主动脉瓣狭窄的患者（80.1±7.6 岁；逻辑 EuroSCORE：16.5±9.9%）。其中男性占 47%（n=432），从不吸烟者占 57%（n=522），既往吸烟者占 35%（n=317），当前吸烟者占 8%（n=74）。与从不吸烟者相比，吸烟者（即既往吸烟者或当前吸烟者）更年轻（78.9±7.9 和 76.4±8.0 与 81.3±7.1，P<0.000）。中位随访时间为 365（四分位距 [IQR]：280-365）天。总体而言，TAVR 后 1 年，既往吸烟与全因死亡率无关（风险比 [HR] 0.83，95%置信区间 [CI] 0.55-1.23）。根据性别分层后，与 TAVR 后从不吸烟者相比，男性既往吸烟者的 1 年生存率更高（12%比 20%；P=0.018，HR 0.52，95%CI 0.29-0.89），而在 TAVR 后女性既往吸烟者与女性从不吸烟者之间未观察到这种逆转效应（HR 1.70，95%CI 0.95-3.05）。
总体而言，与基线从不吸烟者相比，基线既往吸烟者 TAVR 后 1 年死亡率相似。然而，在男性中，基线既往吸烟状况与 TAVR 后 1 年死亡率之间存在相反的关联，这可能部分归因于有利的基线特征。
