女性经导管主动脉瓣置换术后慢性肾脏病的影响：来自女性国际经导管主动脉瓣植入术（WIN-TAVI）注册研究的分析。
The impact of chronic kidney disease in women undergoing transcatheter aortic valve replacement: Analysis from the Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) registry.
机构信息
Icahn School of Medicine at Mount Sinai/Mount Sinai St Luke's Roosevelt, New York, New York.
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
出版信息
Catheter Cardiovasc Interv. 2020 Jul;96(1):198-207. doi: 10.1002/ccd.28752. Epub 2020 Jan 24.
BACKGROUND
The prevalence of both chronic kidney disease (CKD) and aortic stenosis (AS) increase with age. Although baseline CKD is frequent in patients undergoing transcatheter aortic valve replacement (TAVR), its significance among women is largely unknown.
METHODS
Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) is a multinational, prospective registry of women undergoing TAVR for severe AS. We included patients with available baseline estimated glomerular filtration rate (eGFR) and completed 1-year follow-up. Patients were categorized into three groups based on their eGFR: No CKD (normal kidney function to stage 2 CKD: eGFR ≥60 ml/min/1.73 m ); (b) mild CKD (stage 3a CKD: eGFR = 45-59 ml/min/1.73 m ); and (c) moderate/severe CKD (stage ≥3b CKD: eGFR <45 ml/min/1.73 m ). All events were adjudicated according to the Valve Academic Research Consortium (VARC)-2 criteria.
RESULT
Out of 852 women undergoing TAVR, 326 (38.3%) had no CKD, 225 (26.4%) had mild CKD, and 301 (35.3%) had moderate/severe CKD. Women with higher stage of CKD at baseline were more likely to have a history of hypertension, diabetes, atrial fibrillation, anemia, chronic lung disease, hemodialysis, prior percutaneous coronary intervention, and pacemaker implantation. After multivariate adjustment, moderate/severe CKD was associated with a greater risk of 1-year VARC-2 safety endpoints [hazard ratio (HR) 1.68, 95% confidence interval (CI): 1.10-2.60], all-cause death (HR 2.00, 95% CI: 1.03-3.90), and composite of death, myocardial infarction, stroke or life-threatening bleeding (HR 1.70, 95% CI: 1.04-2.76). There were no differences in 30-day and 1-year VARC-2 efficacy and 30-day VARC-2 safety outcomes.
CONCLUSION
CKD is associated with substantial and independent risk for mortality and morbidity at 1-year follow-up in women undergoing TAVR.
背景
慢性肾脏病（CKD）和主动脉瓣狭窄（AS）的患病率均随年龄增长而增加。尽管经导管主动脉瓣置换术（TAVR）患者的基线 CKD 较为常见，但女性患者的 CKD 意义尚不清楚。
方法
女性国际经导管主动脉瓣植入术（WIN-TAVI）是一项对接受重度 AS 经导管主动脉瓣置换术的女性患者进行的多中心前瞻性注册研究。我们纳入了有基线估算肾小球滤过率（eGFR）并完成 1 年随访的患者。根据患者的 eGFR 将其分为三组：无 CKD（正常肾功能至 2 期 CKD：eGFR≥60ml/min/1.73m）；轻度 CKD（3a 期 CKD：eGFR=45-59ml/min/1.73m）；和中度/重度 CKD（≥3b 期 CKD：eGFR<45ml/min/1.73m）。所有事件均根据 Valve Academic Research Consortium（VARC）-2 标准进行裁决。
结果
在 852 名接受 TAVR 的女性中，326 名（38.3%）无 CKD，225 名（26.4%）有轻度 CKD，301 名（35.3%）有中度/重度 CKD。基线 CKD 分期较高的女性更有可能患有高血压、糖尿病、心房颤动、贫血、慢性肺部疾病、血液透析、既往经皮冠状动脉介入治疗和起搏器植入史。多变量调整后，中度/重度 CKD 与 1 年 VARC-2 安全性终点（风险比[HR]1.68，95%置信区间[CI]：1.10-2.60）、全因死亡（HR 2.00，95%CI：1.03-3.90）和死亡、心肌梗死、卒中和威胁生命的出血的复合终点（HR 1.70，95%CI：1.04-2.76）的风险增加相关。30 天和 1 年的 VARC-2 疗效和 30 天的 VARC-2 安全性结局没有差异。
结论
在接受 TAVR 的女性中，CKD 与 1 年随访时的死亡率和发病率有实质性的独立相关性。
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