ACTION Study Group, Inserm UMRS 1166, institut de cardiologie, Sorbonne université, hôpital universitaire Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
Cardiology department, Nantes university hospital, 44000 Nantes, France.
Arch Cardiovasc Dis. 2019 Dec;112(12):765-772. doi: 10.1016/j.acvd.2019.09.008. Epub 2019 Nov 20.
The incidence of and risk factors for readmission for heart failure after successful transcatheter aortic valve implantation (TAVI) are unclear.
We sought to evaluate the incidence of, risk factors for and clinical impact of readmission for heart failure after successful TAVI in an unselected patient population.
All patients who underwent successful TAVI in two high-volume French tertiary centres from February 2010 to December 2016 were included prospectively and followed up for 1 year. A Cox multivariable model was used to assess risk factors for readmission for heart failure and mortality.
A total of 1139 patients (mean age 82.4±7.7years; 52.2% male sex) were included. Readmission for heart failure occurred in 99 (9.2%) patients. Risk factors for readmission for heart failure were previous atrial fibrillation (adjusted hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.09-2.40), diabetes mellitus (HR 1.67, 95% CI 1.11-2.50), chronic kidney disease (HR 1.72, 95% CI 1.13-2.62), chronic pulmonary disease (HR 1.81, 95% CI 1.17-2.81) and left ventricular ejection fraction after TAVI ≤ 35% (HR 2.12, 95% CI 1.20-3.75). Readmission for heart failure was strongly associated with mortality (HR 3.11, 95% CI 1.95-4.94), along with increased Society of Thoracic Surgeons' score (HR 1.07, 95% CI 1.03-1.12), chronic pulmonary disease (HR 1.45, 95% CI 1.00-2.09), previous atrial fibrillation (HR 2.11, 95% CI 1.52-2.93) and shock during the index hospitalization (HR 2.56, 95% CI 1.41-4.65).
Readmission for heart failure occurs in one in 10 patients after successful TAVI, and is a strong risk factor for mortality. Co-morbidities and left ventricular ejection fraction after TAVI≤35% are the main risk factors for readmission for heart failure.
经导管主动脉瓣置换术（TAVI）成功后心力衰竭再入院的发生率和危险因素尚不清楚。
我们旨在评估在未选择的患者人群中，TAVI 成功后心力衰竭再入院的发生率、危险因素和临床影响。
前瞻性纳入 2010 年 2 月至 2016 年 12 月在两个法国高容量三级中心接受成功 TAVI 的所有患者，并随访 1 年。使用 Cox 多变量模型评估心力衰竭再入院和死亡率的危险因素。
共纳入 1139 例患者（平均年龄 82.4±7.7 岁；52.2%为男性）。99 例（9.2%）患者发生心力衰竭再入院。心力衰竭再入院的危险因素包括既往心房颤动（校正风险比 [HR] 1.62，95%置信区间 [CI] 1.09-2.40）、糖尿病（HR 1.67，95% CI 1.11-2.50）、慢性肾脏病（HR 1.72，95% CI 1.13-2.62）、慢性肺部疾病（HR 1.81，95% CI 1.17-2.81）和 TAVI 后左心室射血分数≤35%（HR 2.12，95% CI 1.20-3.75）。心力衰竭再入院与死亡率密切相关（HR 3.11，95% CI 1.95-4.94），同时与胸外科医生协会评分增加（HR 1.07，95% CI 1.03-1.12）、慢性肺部疾病（HR 1.45，95% CI 1.00-2.09）、既往心房颤动（HR 2.11，95% CI 1.52-2.93）和指数住院期间休克（HR 2.56，95% CI 1.41-4.65）有关。
TAVI 成功后，心力衰竭再入院发生率为每 10 例患者中就有 1 例，是死亡的强烈危险因素。合并症和 TAVI 后左心室射血分数≤35%是心力衰竭再入院的主要危险因素。
