Kolte Dhaval, Beale Charles, Aronow Herbert D, Kennedy Kevin F, Apostolidou Eirini, Sellke Frank W, Sharaf Barry L, Gordon Paul C, Abbott J Dawn, Ehsan Afshin
The Warren Alpert Medical School of Brown University, Providence, RI; Lifespan Cardiovascular Institute, Providence, RI.
Lifespan Cardiovascular Institute, Providence, RI.
J Thorac Cardiovasc Surg. 2020 Jan;159(1):102-111.e11. doi: 10.1016/j.jtcvs.2019.03.043. Epub 2019 Mar 28.
To examine temporal trends, predictors, and outcomes of red blood cell (RBC) transfusion in patients undergoing transcatheter aortic valve replacement (TAVR) in the United States.
We used the National Inpatient Sample databases to identify TAVR procedures performed between January 2012 and September 2015 in the United States. Patients were propensity matched (within the strata of overt and no bleeding) on the likelihood of receiving RBC transfusion, and in-hospital outcomes were compared between the 2 groups in the matched cohort.
Among 46,710 TAVR procedures performed during the study period, rates of RBC transfusion were 17.3% (95% confidence interval [CI], 16.1%-18.5%). RBC transfusion rates decreased significantly from 29.5% during the first quarter of 2012 to 10.8% during the third quarter of 2015 (P < .001). Older age, female sex, peripheral vascular disease, chronic kidney disease, anemia, coagulopathy, and fluid/electrolyte disorders were associated with increased odds, whereas elective admission, obesity, and endovascular access were associated with decreased odds of RBC transfusion. In the propensity-matched cohort (7995 pairs with and without RBC transfusion), RBC transfusion was associated with increased risk of in-hospital mortality, infection, and transient ischemic attack/stroke in patients without bleeding (odds ratio [OR], 2.29; 95% CI, 1.31-4.02; OR, 2.13; 95% CI, 1.03-4.39; OR 3.36; 95% CI, 1.52-7.45), but not in those with overt bleeding (OR, 1.10; 95% CI, 0.68-1.48; OR, 0.80; 95% CI, 0.45-1.45; OR, 1.16; 95% CI, 0.74-1.85); P < .05 for all.
RBC transfusion is associated with worse clinical outcomes in TAVR patients without bleeding, but not in those with overt bleeding. The utility and optimal threshold for RBC transfusion in TAVR patients, especially among those with overt bleeding, warrants further prospective investigation.
研究美国经导管主动脉瓣置换术（TAVR）患者红细胞（RBC）输注的时间趋势、预测因素及结局。
我们使用国家住院样本数据库来识别2012年1月至2015年9月在美国进行的TAVR手术。根据接受RBC输注的可能性对患者进行倾向匹配（在明显出血和无出血分层内），并比较匹配队列中两组的院内结局。
在研究期间进行的46,710例TAVR手术中，RBC输注率为17.3%（95%置信区间[CI]，16.1%-18.5%）。RBC输注率从2012年第一季度的29.5%显著下降至2015年第三季度的10.8%（P <.001）。年龄较大、女性、外周血管疾病、慢性肾脏病、贫血、凝血病以及液体/电解质紊乱与RBC输注几率增加相关，而择期入院、肥胖和血管内入路与RBC输注几率降低相关。在倾向匹配队列（7995对有和无RBC输注的患者）中，RBC输注与无出血患者的院内死亡、感染及短暂性脑缺血发作/中风风险增加相关（优势比[OR]，2.29；95% CI，1.31-4.02；OR，2.13；95% CI，1.03-4.39；OR 3.36；95% CI，1.52-7.45），但在有明显出血的患者中并非如此（OR，1.10；95% CI，0.68-1.48；OR，0.80；95% CI，0.45-1.45；OR，1.16；95% CI，0.74-1.85）；所有P值均<.05。
RBC输注与无出血的TAVR患者较差的临床结局相关，但与有明显出血的患者无关。TAVR患者尤其是有明显出血患者RBC输注的效用及最佳阈值值得进一步前瞻性研究。
