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经导管主动脉瓣植入术后再入院的原因和预测因素:荟萃分析和系统评价。

Causes and predictors of readmission after transcatheter aortic valve implantation : A meta-analysis and systematic review.

机构信息

Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China.

Zhejiang Provincial People's Hospital, Hangzhou, China.

出版信息

Herz. 2021 Apr;46(Suppl 1):1-8. doi: 10.1007/s00059-019-04870-6. Epub 2019 Dec 5.


DOI:10.1007/s00059-019-04870-6
PMID:31807789
Abstract

BACKGROUND: Since readmission rate is an important clinical index to determine the quality of inpatient care and hospital performance, the aim of this study was to explain the causes and predictors of readmission following transcatheter aortic valve implantation (TAVI) at short-term and mid-term follow-up. METHODS AND RESULTS: A systematic review and meta-analysis of all published articles from Embase, Pubmed/MEDLINE, and Ovid was carried out. In all, 10 studies including 52,702 patients were identified. The pooled estimate for the overall event rate was 0.15, and cardiovascular causes were the main reason for 30-day readmission (0.42, 95% confidence interval [CI]: 0.39-0.45). In addition, the pooled incidence of 1‑year readmission was 0.31, and cardiovascular events were still the main cause (0.41, 95% CI: 0.33-0.48). Patients with major and life-threatening bleeding, new permanent pacemaker implantation, and clinical heart failure were associated with a high risk for early readmission after TAVI. Moreover, an advanced (≥3) New York Heart Association classification, acute kidney injury, paravalvular leak, mitral regurgitation (≥ moderate), and major bleeding predicted unfavorable outcome to 1‑year readmission. Female gender and transfemoral TAVI was associated with a lower risk for unplanned rehospitalization. CONCLUSIONS: This meta-analysis found cardiovascular factors to be the main causes for both 30-day and 1‑year rehospitalization. Heart failure represented the most common cardiovascular event at both short-term and mid-term follow-up. Several baseline characteristics and procedure-related factors were deemed unfavorable predictors of readmission. Importantly, transfemoral access and female gender were associated with a lower risk of readmission.

摘要

背景:由于再入院率是衡量住院患者护理质量和医院绩效的重要临床指标,因此本研究旨在解释经导管主动脉瓣置换术(TAVI)后短期和中期随访时再入院的原因和预测因素。

方法和结果:对 Embase、Pubmed/MEDLINE 和 Ovid 中所有已发表文章进行了系统评价和荟萃分析。共纳入 10 项研究,总计 52702 例患者。汇总估计的总体事件发生率为 0.15,心血管原因是 30 天再入院的主要原因(0.42,95%置信区间[CI]:0.39-0.45)。此外,1 年再入院的累积发生率为 0.31,心血管事件仍然是主要原因(0.41,95%CI:0.33-0.48)。TAVI 后早期再入院风险较高的患者包括有重大和危及生命的出血、新植入永久性起搏器和临床心力衰竭。此外,纽约心脏协会(NYHA)分级较高(≥3)、急性肾损伤、瓣周漏、二尖瓣反流(≥中度)和大出血预测 1 年再入院的不良预后。女性和经股 TAVI 与计划外再住院的风险降低相关。

结论:本荟萃分析发现心血管因素是 30 天和 1 年再入院的主要原因。心力衰竭是短期和中期随访时最常见的心血管事件。一些基线特征和手术相关因素被认为是再入院的不利预测因素。重要的是,经股入路和女性与较低的再入院风险相关。

相似文献

[1]
Causes and predictors of readmission after transcatheter aortic valve implantation : A meta-analysis and systematic review.

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[2]
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[3]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
Impact of aortic angulation on outcomes in transcatheter aortic valve replacement with balloon-expandable and self-expanding valves: a systematic review and meta-analysis.

Cardiovasc Interv Ther. 2025-7-18

[2]
Impact of serum haemoglobin-to-creatinine ratio after transcatheter aortic valve implantation.

Open Heart. 2023-12-2

[3]
Predictors Of Post-Operative Negative Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation.

Br J Card Nurs. 2022-8-30

[4]
Clinical outcomes of bicuspid versus tricuspid aortic valve stenosis after transcatheter aortic valve replacement with self-expandable valves.

BMC Cardiovasc Disord. 2022-12-12

[5]
Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review.

CJC Open. 2022-6-6

[6]
Readmission and In-Hospital Outcomes After Transcatheter Aortic Valve Replacement in Patients With Dementia.

Cardiovasc Revasc Med. 2023-1

[7]
Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement.

J Pers Med. 2022-4-8

[8]
Diagnostic accuracy of coronary computed tomography angiography for the evaluation of obstructive coronary artery disease in patients referred for transcatheter aortic valve implantation: a systematic review and meta-analysis.

Eur Radiol. 2022-8

[9]
Angiotensin-converting enzyme inhibitor for post-transcatheter aortic valve implantation patients: study protocol for a multicenter randomized, open-label blinded endpoint control trial.

Trials. 2021-7-18

[10]
Causes, pattern, predictors, and prognostic implications of new hospitalizations after transcatheter aortic valve implantation: a long-term nationwide observational study.

Eur Heart J Qual Care Clin Outcomes. 2022-3-2

本文引用的文献

[1]
Association between transitional care factors and hospital readmission after transcatheter aortic valve replacement: a retrospective observational cohort study.

BMC Cardiovasc Disord. 2019-1-18

[2]
Bioprosthetic Valve Performance After Transcatheter Aortic Valve Replacement With Self-Expanding Versus Balloon-Expandable Valves in Large Versus Small Aortic Valve Annuli: Insights From the CHOICE Trial and the CHOICE-Extend Registry.

JACC Cardiovasc Interv. 2018-11-28

[3]
Hospital readmission following transcatheter aortic valve implantation in the real world.

Int J Cardiol. 2018-7-18

[4]
Transcatheter aortic valve implantation: current status and future perspectives.

Eur Heart J. 2018-7-21

[5]
Association of Accelerometry-Measured Physical Activity and Cardiovascular Events in Mobility-Limited Older Adults: The LIFE (Lifestyle Interventions and Independence for Elders) Study.

J Am Heart Assoc. 2017-12-2

[6]
Culprit Vessel-Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Cardiogenic Shock Complicating ST-Segment-Elevation Myocardial Infarction: A Collaborative Meta-Analysis.

Circ Cardiovasc Interv. 2017-11

[7]
Association of Paravalvular Regurgitation With 1-Year Outcomes After Transcatheter Aortic Valve Replacement With the SAPIEN 3 Valve.

JAMA Cardiol. 2017-11-1

[8]
Transcatheter aortic valve implantation with the new-generation Evolut R™: Comparison with CoreValve® in a single center cohort.

Int J Cardiol Heart Vasc. 2016-7-5

[9]
Readmission rates after transcatheter aortic valve replacement in high- and extreme-risk patients with severe aortic stenosis.

J Thorac Cardiovasc Surg. 2017-4-18

[10]
Association Between Hospital Volume and 30-Day Readmissions Following Transcatheter Aortic Valve Replacement.

JAMA Cardiol. 2017-7-1

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