Paleri Sarang, Tham Jodie Li-Mei, Jin David, Chan Yee Sen, Wright Christine, Baradi Arul, Whitbourn Robert J, Adams Heath S L, Palmer Sonny C
Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Department of Medicine, The University of Melbourne, Fitzroy, Victoria, Australia.
Aust J Rural Health. 2019 Jun;27(3):229-236. doi: 10.1111/ajr.12508. Epub 2019 May 10.
To compare clinical and functional outcomes of regional and urban patients after transcatheter aortic valve implantation for severe aortic stenosis.
Data were collected at patient follow-up post-transcatheter aortic valve implantation at 30 days and 12 months. Patients were stratified by residential postcodes into remoteness areas using the Australian Statistical Geography Standard.
Retrospective cohort study.
Single-centre tertiary referral hospital.
Patients undergoing transcatheter aortic valve implantation (n = 142) from 2009 to 2018 were analysed, with 77 patients (54.2%) residing in regional Victoria and New South Wales.
Procedural success, adverse event rates, readmission rates, mortality rates, loss to follow-up and functional improvement.
Patients residing in regional areas had a lower mean age (81.8 vs 83.7 years) and proportion of Stage 4 or 5 chronic kidney disease (1.3% vs 9.2%), compared with urban patients. Procedural characteristics and immediate post-procedural outcomes were similar between both groups. There was no statistically significant difference in mortality, readmission rates or loss to follow-up between the two cohorts. Regional patients demonstrated poorer rates of functional improvement at 30 days (50.7% vs 67.7%); however, this difference was not sustained at 12 months (79.2% vs 71.0%). Frailty was demonstrated to be an independent predictor of poor 30-day functional improvement.
Regional patients treated with transcatheter aortic valve implantation for severe aortic stenosis have non-inferior 30-day and 12-month outcomes, when compared with urban patients. Frailty is a predictor of poor functional improvement post-transcatheter aortic valve implantation.
比较重度主动脉瓣狭窄患者经导管主动脉瓣植入术后农村和城市患者的临床及功能结局。
在经导管主动脉瓣植入术后30天和12个月的患者随访时收集数据。根据澳大利亚统计地理标准，通过居住邮政编码将患者分层为偏远地区。
回顾性队列研究。
单中心三级转诊医院。
分析了2009年至2018年接受经导管主动脉瓣植入术的患者（n = 142），其中77名患者（54.2%）居住在维多利亚州和新南威尔士州农村地区。
手术成功率、不良事件发生率、再入院率、死亡率、失访率和功能改善情况。
与城市患者相比，农村地区患者的平均年龄较低（81.8岁对83.7岁），4期或5期慢性肾病的比例较低（1.3%对9.2%）。两组间手术特征和术后即刻结局相似。两个队列在死亡率、再入院率或失访率方面无统计学显著差异。农村患者在30天时功能改善率较低（50.7%对67.7%）；然而，这种差异在12个月时未持续存在（79.2%对71.0%）。虚弱被证明是30天功能改善不佳的独立预测因素。
与城市患者相比，重度主动脉瓣狭窄患者经导管主动脉瓣植入术后农村患者的30天和12个月结局并不逊色。虚弱是经导管主动脉瓣植入术后功能改善不佳的预测因素。
