Patil Nikita, Strassle Paula D, Arora Sameer, Patel Chinmay, Gangani Kishorbhai, Vavalle John P
Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Cardiovasc Diagn Ther. 2020 Feb;10(1):3-11. doi: 10.21037/cdt.2019.05.05.
Atrial fibrillation (AF) is common in patients undergoing transcatheter aortic valve replacement (TAVR) but there is conflicting evidence on whether AF impacts outcomes after TAVR.
Hospitalizations of adults ≥50 years old who had undergone elective TAVR from 2012 to 2015 were included. Poisson regression was used to assess changes in in-hospital complications, average length of stay (LOS) after TAVR, and discharge disposition over time. Multivariable logistic, linear, and generalized logistic regression models, adjusting for patient and hospital characteristics, were used to estimate the effect of AF on inpatient outcomes.
A total of 7,266 TAVR hospitalizations were included; AF was present in 44% of patients. Between 2012 and 2015, there was a significant decrease in the incidence of acute kidney injury, blood transfusion, average LOS, and inpatient mortality both for AF and non-AF patients. However, the incidences of vascular complications and major bleeding decreased only among non-AF patients. After adjustment, AF was associated with increased incidences of TIA/stroke (OR 1.36, 95% CI: 1.01, 1.85), acute kidney injury (OR 1.54, 95% CI: 1.33, 1.78), blood transfusion (OR 1.14, 95% CI: 1.00, 1.30), transfer to a skilled nursing facility (OR 1.38, 95% CI: 1.23, 1.55), and longer average LOS (CIE 1.30, 95% CI: 1.06, 1.54). AF was not associated with inpatient mortality (OR 1.09, 95% CI: 0.81, 1.48).
AF is prevalent among patients undergoing TAVR, and is associated with higher incidences of inpatient complications, discharge to a skilled nursing facility, and longer average LOS. While the incidence of many complications has declined in the past few years, continued efforts to further reduce complications in patients with AF is urgently required for expansion of TAVR to broader populations.
心房颤动（AF）在接受经导管主动脉瓣置换术（TAVR）的患者中很常见，但关于AF是否会影响TAVR后的结局，证据存在冲突。
纳入2012年至2015年接受择期TAVR的≥50岁成年人的住院病例。采用泊松回归评估住院并发症、TAVR后平均住院时间（LOS）以及出院处置随时间的变化。使用多变量逻辑回归、线性回归和广义逻辑回归模型，并对患者和医院特征进行调整，以估计AF对住院结局的影响。
共纳入7266例TAVR住院病例；44%的患者存在AF。在2012年至2015年期间，AF患者和非AF患者的急性肾损伤、输血、平均LOS和住院死亡率均显著下降。然而，血管并发症和大出血的发生率仅在非AF患者中有所下降。调整后，AF与短暂性脑缺血发作/中风（OR 1.36，95%CI：1.01，1.85）、急性肾损伤（OR 1.54，95%CI：1.33，1.78）、输血（OR 1.14，95%CI：1.00，1.30）、转至专业护理机构（OR 1.38，95%CI：1.23，1.55）以及更长的平均LOS（CIE 1.30，95%CI：1.06，1.54）的发生率增加相关。AF与住院死亡率无关（OR 1.09，95%CI：0.81，1.48）。
AF在接受TAVR的患者中普遍存在，并且与住院并发症、转至专业护理机构以及更长的平均LOS的发生率较高相关。虽然在过去几年中许多并发症的发生率有所下降，但迫切需要继续努力进一步降低AF患者的并发症，以便将TAVR扩展到更广泛的人群。
