Department of Cardiology - Liaoning Provincial Jin Qiu Hospital, Liaoning Province - China.
Department of Cardiology - Liaoning Provincial People's Hospital, Liaoning Province - China.
Arq Bras Cardiol. 2019 Apr;112(4):432-438. doi: 10.5935/abc.20190060. Epub 2019 Apr 1.
The analysis of risk factors for predicting related complications has not been reported to date.
This study aims to investigate the risk factors of related complications of percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM) retrospectively.
Clinical data, and one-year follow-up results of patients with HOCM, who underwent PTSMA between January 2000 and July 2013 in the Department of Cardiology, Liaoning Province People's Hospital, Liaoning Province, China, were retrospectively analyzed to determine risk factors for operative complications with multiple logistic regression analysis. All p values are two-sided, with values of p < 0.05 being considered statistically significant.
Among 319 patients with HOCM, PTSMA was performed in 224 patients (120 males and 104 females, mean age was 48.20 ± 14.34 years old). The incidence of PTSMA procedure-related complications was 36.23% (66/224), which included three cardiac deaths, two cardiac shocks, one ST-segment elevated myocardial infarction, two ventricular fibrillations, 20 third-degree atrioventricular (AV) blocks (four patients were implanted with a permanent pacemaker (PPM)), 32 complete right bundle branch blocks, two complete left bundle branch blocks, and four puncture-related complications. After multivariate logistic regression analysis, it was found that age, gender, coronary artery diseases, diabetes, heart rate, cardiac function on admission, the number of septal ablations, and the volume of alcohol were not independent risk factors correlated to the whole complications, except for hypertension (OR: 4.856; 95% CI: 1.732-13.609). Early experience appears to be associated with the occurrence of complications.
Hypertension was an independent risk factor for PTSMA procedure-related complications. It might be much safer and more efficient if PTSMA procedures are restricted to experienced centers, according to the analysis results for the learning curve.
目前尚未有分析预测经皮腔内室间隔心肌消融术（PTSMA）相关并发症的危险因素的报道。
本研究旨在回顾性分析辽宁省人民医院心内科 2000 年 1 月至 2013 年 7 月行 PTSMA 的肥厚型梗阻性心肌病（HOCM）患者的临床资料及 1 年随访结果，采用多因素 logistic 回归分析确定手术相关并发症的危险因素。所有 p 值均为双侧，p＜0.05 为差异有统计学意义。
319 例 HOCM 患者中，224 例行 PTSMA（男 120 例，女 104 例，平均年龄 48.20±14.34 岁）。PTSMA 相关并发症发生率为 36.23%（66/224），包括 3 例心脏性死亡、2 例心脏电复律、1 例 ST 段抬高型心肌梗死、2 例心室颤动、20 例三度房室传导阻滞（4 例植入永久性起搏器）、32 例完全性右束支阻滞、2 例完全性左束支阻滞、4 例穿刺相关并发症。多因素 logistic 回归分析显示，年龄、性别、冠状动脉疾病、糖尿病、心率、入院时心功能、室间隔消融次数及酒精用量均不是与全因并发症相关的独立危险因素，而高血压是（OR：4.856；95%CI：1.732~13.609）。早期经验似乎与并发症的发生有关。
高血压是 PTSMA 相关并发症的独立危险因素。根据学习曲线的分析结果，PTSMA 手术如果仅限于有经验的中心进行，可能会更安全、更有效。
