Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida; Jackson Memorial Hospital, Miami, Florida.
Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida; Jackson Memorial Hospital, Miami, Florida.
Am J Cardiol. 2021 Mar 1;142:109-115. doi: 10.1016/j.amjcard.2020.11.029. Epub 2020 Dec 4.
A history of malignancy is incorporated in the Society of Thoracic Surgeons score to assess presurgical risk in patients undergoing surgical aortic valve replacement, however data on the prognostic importance in those undergoing transcatheter aortic valve implantation (TAVI) remains limited. We sought to investigate the utilization and in-hospital outcomes of TAVI in patients with a history of malignancy. The National Inpatient Sample Database was queried from 2012 to 2017 to identify patients who underwent TAVI using International Classification of Diseases (ICD) 9 and ICD-10 procedure codes. Between 2012 and 2017, there were 123,070 patients who underwent TAVI, of these 23,670 patients (19.2%) had a previous history of malignancy. The proportion of patients undergoing TAVI with a history of malignancy trended upward between 2012 and 2017. Patients with a history of malignancy were similar in age to those without (81.1 ± 7.9 vs 80.1 ± 6.7 years old, p <0.001), with a higher prevalence of tobacco use and major depressive disorder (p <0.001 for both). Patients with a history of malignancy had higher rates of post-TAVI pacemaker implantation (p <0.001), otherwise periprocedural complication rates were similar to those without. Using a multivariate logistic regression model to adjust for confounding factors, a history of malignancy was predictive of decreased odds of death in patients underwent TAVI (OR: 0.67, 95% CI, 0.60 to 0.76, p <0.001) and higher odds of pacemaker implantation (OR: 1.14, 95% CI, 1.09 to 1.19, p <0.001). In conclusion, with time the proportion of TAVI patients with a history of malignancy trended upward. Despite a greater prevalence of previous tobacco use and major depressive disorder, patients with a history of malignancy had TAVI safely with a low in-hospital all-cause mortality, yet greater cost of hospitalization and more frequent implantation of pacemaker devices.
恶性肿瘤病史被纳入胸外科医生协会评分中，以评估接受主动脉瓣置换手术的患者的术前风险，然而，关于经导管主动脉瓣植入术（TAVI）患者中该因素的预后重要性的数据仍然有限。我们旨在研究 TAVI 在有恶性肿瘤病史的患者中的应用和院内结局。我们从 2012 年至 2017 年，使用国际疾病分类（ICD）第 9 版和 ICD-10 手术代码，在国家住院患者样本数据库中查询了接受 TAVI 的患者。在 2012 年至 2017 年期间，共有 123070 例患者接受了 TAVI，其中 23670 例（19.2%）有恶性肿瘤病史。在这段时间内，有恶性肿瘤病史的患者接受 TAVI 的比例呈上升趋势。有恶性肿瘤病史的患者与无恶性肿瘤病史的患者年龄相仿（81.1±7.9 岁 vs 80.1±6.7 岁，p<0.001），但前者更常吸烟和患有重度抑郁症（均 p<0.001）。有恶性肿瘤病史的患者 TAVI 术后起搏器植入率更高（p<0.001），但围手术期并发症发生率与无恶性肿瘤病史的患者相似。使用多变量逻辑回归模型调整混杂因素后，恶性肿瘤病史是 TAVI 患者死亡风险降低的预测因素（OR：0.67，95%CI：0.60 至 0.76，p<0.001），且是起搏器植入风险增加的预测因素（OR：1.14，95%CI：1.09 至 1.19，p<0.001）。总之，随着时间的推移，有恶性肿瘤病史的 TAVI 患者的比例呈上升趋势。尽管恶性肿瘤病史患者的既往吸烟和重度抑郁症更为常见，但他们接受 TAVI 治疗是安全的，院内全因死亡率较低，然而住院费用更高，需要更频繁地植入起搏器。
