Takagi Hisato, Kuno Toshiki, Hari Yosuke, Nakashima Kouki, Yokoyama Yujiro, Ueyama Hiroki, Ando Tomo
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
J Card Surg. 2020 May;35(5):974-980. doi: 10.1111/jocs.14499. Epub 2020 Mar 11.
To determine whether baseline C-reactive protein (CRP) levels can predict mortality after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of currently available studies.
All studies investigating the prognostic impact of baseline (preprocedural) CRP levels on all-cause mortality after TAVI were identified by means of searching PubMed and Google Scholar through May 2019. For each study, (preferentially, adjusted rather than unadjusted) odds/hazard ratios (ORs/HRs) with corresponding 95% confidence intervals of mortality per standard-deviation (SD) (or unit) increase in CRP levels or those for high vs low CRP levels.
Our search identified 14 eligible studies including a total of 3449 patients undergoing TAVI and reporting early (in-hospital to 3-month) and midterm (1-year to 3-year) all-cause mortality after TAVI. Pooled analyses demonstrated associations of high-baseline CRP levels with a marginal, but statistically nonsignificant increase in early mortality (pooled OR/HR per SD increase in CRP levels, 2.72; P = .09 and pooled OR/HR for high vs low CRP levels, 3.32; P = .07) and a statistically significant increase in midterm mortality after TAVI (pooled OR/HR per SD increase in CRP levels, 1.45; P < .0001 and pooled OR/HR for high vs low CRP levels, 1.78; P < .00001). Excluding HRs for high-sensitivity CRP, combining ORs/HRs of 1-year mortality, pooling HRs of ≥2-year mortality, and combining adjusted HRs did not alter the primary results.
High-baseline CRP levels may predict increased midterm, but not early, mortality after TAVI.
为了确定基线C反应蛋白（CRP）水平是否能够预测经导管主动脉瓣植入术（TAVI）后的死亡率，我们对现有研究进行了一项荟萃分析。
通过检索截至2019年5月的PubMed和谷歌学术，确定了所有研究基线（术前）CRP水平对TAVI后全因死亡率预后影响的研究。对于每项研究，（优先采用调整而非未调整的）比值比/风险比（ORs/HRs）以及CRP水平每增加一个标准差（SD）（或单位）或高CRP水平与低CRP水平相比时死亡率的相应95%置信区间。
我们的检索确定了14项符合条件的研究，共纳入3449例行TAVI的患者，并报告了TAVI后的早期（住院至3个月）和中期（1年至3年）全因死亡率。汇总分析表明，基线CRP水平高与早期死亡率有边缘性但无统计学意义的增加相关（CRP水平每增加一个SD的汇总OR/HR为2.72；P = 0.09，高CRP水平与低CRP水平相比的汇总OR/HR为3.32；P = 0.07），以及TAVI后中期死亡率有统计学意义的增加（CRP水平每增加一个SD的汇总OR/HR为1.45；P < 0.0001，高CRP水平与低CRP水平相比的汇总OR/HR为1.78；P < 0.00
