Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
Am J Cardiol. 2019 Jun 15;123(12):1978-1982. doi: 10.1016/j.amjcard.2019.03.016. Epub 2019 Mar 16.
Increased inflammatory response after aortic valve replacement is linked to higher postprocedural mortality. The aim of the present analysis was to assess the impact of baseline statin therapy on procedural outcomes and mortality after transcatheter aortic valve implantation (TAVI). We performed a retrospective analysis on patients who underwent TAVI stratified to 3 statin therapy groups: high-intensity statin (HIS), low-medium intensity statins, and no statin. Included were 1,238 patients. Patients treated with HIS were significantly younger, had higher body mass index, lower Society of Thoracic Surgeons score, and higher prevalence of dyslipidemia, hypertension, past stroke, and ischemic heart disease. Procedural outcomes were similar between groups. There were no statistically significant short-term mortality differences at 1 month (2.2% vs 2.1% vs 3.5%, p = 0.50) and 1 year (6.9% vs 9.3% vs 14.2%, p = 0.15), albeit the observed numerical trend. As for long-term mortality (median follow time of 2.5 years, interquartile range 1.3 to 4.2), lower mortality rates were observed in the HIS group (14.5% vs 25.2% vs 36.6%, p = 0.001). Compared with no statin, the HIS group was significantly associated with reduced risk of long-term mortality in multivariate analysis (hazard ratio = 0.59, 95% CI 0.37 to 0.96, p = 0.03). Baseline HIS therapy is associated with reduced rates of long-term morality after TAVI.
主动脉瓣置换术后炎症反应增加与较高的术后死亡率相关。本分析的目的是评估基线他汀类药物治疗对经导管主动脉瓣植入术（TAVI）后手术结果和死亡率的影响。我们对接受 TAVI 的患者进行了回顾性分析，将其分层为 3 组他汀类药物治疗：高强度他汀类药物（HIS）、低-中强度他汀类药物和无他汀类药物。共纳入 1238 例患者。接受 HIS 治疗的患者明显更年轻，体重指数更高，胸外科医生协会评分更低，血脂异常、高血压、既往中风和缺血性心脏病的患病率更高。各组间手术结果相似。1 个月（2.2%比 2.1%比 3.5%，p=0.50）和 1 年（6.9%比 9.3%比 14.2%，p=0.15）的短期死亡率无统计学差异，尽管存在观察到的数值趋势。对于长期死亡率（中位数随访时间为 2.5 年，四分位距 1.3 至 4.2），HIS 组的死亡率较低（14.5%比 25.2%比 36.6%，p=0.001）。与无他汀类药物相比，在多变量分析中，HIS 组与长期死亡率降低显著相关（风险比=0.59，95%置信区间 0.37 至 0.96，p=0.03）。基线 HIS 治疗与 TAVI 后长期死亡率降低相关。
