Carmona Adrien, Marchandot Benjamin, Severac François, Kibler Marion, Trimaille Antonin, Heger Joe, Peillex Marilou, Matsushita Kensuke, Ristorto Jessica, Hoang Viet Anh, Hess Sébastien, Jesel Laurence, Ohlmann Patrick, Morel Olivier
Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67000 Strasbourg, France.
Department of Biostatistics, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67000 Strasbourg, France.
J Clin Med. 2020 Jul 16;9(7):2267. doi: 10.3390/jcm9072267.
The impact of coronary artery disease (CAD) and revascularization by percutaneous coronary intervention (PCI) on prognosis in patients undergoing transcatheter aortic valve replacement (TAVR) remain debated. A dismal prognosis in patients undergoing PCI has been associated with elevated baseline SYNTAX score (bSS) and residual SYNTAX score (rSS). The objective was to investigate whether the degree of bSS and rSS impacted ischemic and bleeding events after TAVR.
bSS and rSS were calculated in 311 patients admitted for TAVR. The primary outcome was the occurrence of major adverse cardiac events (MACE), a composite endpoint of myocardial infarction, stroke, cardiovascular death, or rehospitalization for heart failure. The occurrence of late major/life-threatening bleeding complications (MLBCs) and each primary endpoint individually were the secondary endpoints.
bSS > 22 was associated with higher occurrence of MACE ( = 0.013). rSS > 8 and bSS > 22 had no impact on overall cardiovascular mortality. rSS > 8 and bSS > 22 were associated with higher rates of myocardial infarction ( = 0.001 and = 0.004) and late occurrence of MLBCs. Multivariate analysis showed that bSS > 22 (sHR 2.48) and rSS > 8 (sHR 2.35) remained predictors of MLBCs but not of myocardial infarction.
Incomplete coronary revascularization and CAD burden did not impact overall and cardiac mortality but constitute predictors of late MLBCs in TAVR patients.
冠状动脉疾病（CAD）及经皮冠状动脉介入治疗（PCI）进行血运重建对经导管主动脉瓣置换术（TAVR）患者预后的影响仍存在争议。接受PCI治疗的患者预后不佳与基线SYNTAX评分（bSS）及残余SYNTAX评分（rSS）升高有关。目的是研究bSS和rSS的程度是否会影响TAVR术后的缺血和出血事件。
对311例因TAVR入院的患者计算bSS和rSS。主要结局是发生主要不良心脏事件（MACE），这是一个包括心肌梗死、中风、心血管死亡或因心力衰竭再次住院的复合终点。晚期严重/危及生命的出血并发症（MLBC）的发生情况以及每个主要终点单独作为次要终点。
bSS>22与MACE发生率较高相关（P = 0.013）。rSS>8和bSS>22对总体心血管死亡率无影响。rSS>8和bSS>22与较高的心肌梗死发生率相关（P = 0.001和P = 0.004）以及MLBC的晚期发生。多变量分析显示，bSS>22（sHR 2.48）和rSS>8（sHR 2.35）仍然是MLBC的预测因素，但不是心肌梗死的预测因素。
冠状动脉血运重建不完全和CAD负担并未影响总体死亡率和心脏死亡率，但构成TAVR患者晚期MLBC的预测因素。
