Department of General Medicine, University of Missouri Health Care, Columbia, MO, United States of America.
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America.
Cardiovasc Revasc Med. 2020 Jun;21(6):741-744. doi: 10.1016/j.carrev.2019.10.025. Epub 2019 Nov 6.
Coronary artery disease is a common diagnosis among patients evaluated for transcatheter aortic valve replacement (TAVR). It is unknown whether the presence of coronary artery chronic total occlusion (CTO) has any impact on TAVR post-procedural in-hospital outcomes.
The study population was extracted from the 2016 Nationwide Readmissions Data using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for TAVR, coronary CTO and post-procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospital stay, paravalvular leak (PVL), mechanical complications of prosthetic valve, cardiogenic shock, acute myocardial infarction (AMI), acute kidney injury (AKI), need for a permanent pacemaker, and bleeding. Propensity matching was used to extract a matched control (TAVR-M group to TAVR-CTO group).
There were 23,604 TAVR, of whom, 467 discharges were identified in each group. Baseline characteristics and comorbidities were comparable. Mean age was 80.5 years and 45.9% were female. In comparison to TAVR-M, TAVR-CTO was associated with longer length of stay (8.1 versus 5.9 days, p < 0.01), and higher incidence of post-procedural cardiogenic shock (5.1% versus 1.7%, p < 0.01), AMI (5.8% versus 2.8%, p = 0.02), and AKI (18.6% versus 13.9, p = 0.048). There was no significant difference between the two groups in in-hospital all-cause mortality (1.7% versus 2.4%, p = 0.49), PVL (1.3% versus 0.4%, p = 0.16), mechanical complications of prosthetic valve (0.4% versus 0.9%, p = 0.41), permanent pacemaker (11.6% versus 8.1%, p = 0.07), or bleeding (20.6% versus 19.7%, p = 0.74).
In comparison to TAVR-M, TAVR-CTO was associated with a higher incidence of cardiogenic shock, AMI, and AKI and longer LOS but similar mortality.
在接受经导管主动脉瓣置换术（TAVR）评估的患者中，冠状动脉疾病是常见的诊断。目前尚不清楚冠状动脉慢性完全闭塞（CTO）的存在是否会对 TAVR 术后住院期间的结局产生任何影响。
该研究人群从 2016 年全国再入院数据中提取，使用国际疾病分类、第十版临床修改/程序编码系统对 TAVR、冠状动脉 CTO 和术后并发症进行编码。研究终点包括住院期间全因死亡率、住院指数、瓣周漏（PVL）、人工瓣膜机械并发症、心源性休克、急性心肌梗死（AMI）、急性肾损伤（AKI）、需要永久性起搏器和出血。采用倾向匹配法从 TAVR-M 组和 TAVR-CTO 组中提取匹配对照组（TAVR-M 组）。
共有 23604 例 TAVR，其中每组有 467 例出院。基线特征和合并症相似。平均年龄为 80.5 岁，45.9%为女性。与 TAVR-M 相比，TAVR-CTO 与更长的住院时间（8.1 天比 5.9 天，p<0.01）和更高的术后心源性休克发生率（5.1%比 1.7%，p<0.01）、AMI（5.8%比 2.8%，p=0.02）和 AKI（18.6%比 13.9%，p=0.048）相关。两组住院期间全因死亡率（1.7%比 2.4%，p=0.49）、PVL（1.3%比 0.4%，p=0.16）、人工瓣膜机械并发症（0.4%比 0.9%，p=0.41）、永久性起搏器（11.6%比 8.1%，p=0.07）或出血（20.6%比 19.7%，p=0.74）无显著差异。
与 TAVR-M 相比，TAVR-CTO 与心源性休克、AMI 和 AKI 发生率升高和住院时间延长相关，但死亡率相似。
