Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania.
Internal Medicine, Rochester General Hospital, Rochester, New York.
Am J Cardiol. 2021 Mar 15;143:97-103. doi: 10.1016/j.amjcard.2020.12.031. Epub 2020 Dec 30.
Existing surgical aortic valve replacement risk models accurately predict the post- surgical aortic valve replacement morbidity and mortality, but factors associated with post transcatheter aortic valve Implantation (TAVI) mortality are not well known. The National Inpatient Sample was queried to identify all cases of TAVI. The association of baseline comorbidities with in-hospital mortality was determined using a binary logistic regression model to obtain adjusted odds ratios (aOR). A total of 161,049 patients underwent TAVI between 2010 and 2017. Of these, 157,151 (97.6%) survived while 3,898 (2.4%) died during hospitalization. The baseline characteristics of TAVI-survivors and non-survivors showed a significant amount of variation, including age (80 vs 82 years, p ≤ 0.0001) and female sex (46% vs 52%, p ≤ 0.0001), respectively. The non-survivors had significantly higher adjusted odds of renal failure requiring hemodialysis (aOR 2.59, 95% CI 2.24 to 2.99, p ≤ 0.0001), history of mediastinal radiation (aOR 2.71, 95% CI 1.02 to 7.20, p = 0.05), liver disease (aOR 3.04, 95% CI 2.63 to 3.51, p ≤ 0.0001), pneumonia (aOR 2.47, 95% CI 2.15 to 2.83, p ≤ 0.0001), cardiogenic shock (aOR 9.83, 95% CI 8.93 to 10.82, p ≤ 0.0001), ventricular tachycardia (aOR 2.12, 95% CI 1.88 to 2.40, p ≤ 0.0001), acute ST-elevation myocardial infarction (aOR 7.38, 95% CI 5.53 to 9.84, p ≤ 0.0001), stroke (aOR 2.25, 95% CI 1.99 to 2.54, p ≤ 0.0001), and acute infective endocarditis (aOR 5.74, 95% CI 3.65 to 9.02, p ≤ 0.0001) compared to TAVI-survivors. The yearly trend of mortality showed an increase in the absolute number of TAVI procedures and mortality but the yearly rate showed a decline in mortality after an initial peak during 2012.Patients with renal failure on dialysis, ST-elevation myocardial infarction, cardiogenic shock, infective endocarditis, liver disease and pneumonia have a higher rate of in-hospital mortality post TAVI.
现有的主动脉瓣置换手术风险模型能够准确预测手术后的主动脉瓣置换术发病率和死亡率，但与经导管主动脉瓣植入术（TAVI）死亡率相关的因素尚不清楚。本研究使用二元逻辑回归模型来确定基线合并症与住院死亡率之间的关联，以获得调整后的优势比（aOR）。2010 年至 2017 年期间共 161049 例患者接受了 TAVI 治疗。其中，157151 例（97.6%）存活，3898 例（2.4%）在住院期间死亡。TAVI 存活者和非存活者的基线特征显示出明显的差异，包括年龄（80 岁 vs 82 岁，p ≤ 0.0001）和女性（46% vs 52%，p ≤ 0.0001）。与 TAVI 存活者相比，非存活者发生需要血液透析的肾衰竭的调整后优势比更高（aOR 2.59，95%CI 2.24 至 2.99，p ≤ 0.0001）、有纵隔放疗史（aOR 2.71，95%CI 1.02 至 7.20，p=0.05）、肝病（aOR 3.04，95%CI 2.63 至 3.51，p ≤ 0.0001）、肺炎（aOR 2.47，95%CI 2.15 至 2.83，p ≤ 0.0001）、心源性休克（aOR 9.83，95%CI 8.93 至 10.82，p ≤ 0.0001）、室性心动过速（aOR 2.12，95%CI 1.88 至 2.40，p ≤ 0.0001）、急性 ST 段抬高型心肌梗死（aOR 7.38，95%CI 5.53 至 9.84，p ≤ 0.0001）、中风（aOR 2.25，95%CI 1.99 至 2.54，p ≤ 0.0001）和急性感染性心内膜炎（aOR 5.74，95%CI 3.65 至 9.02，p ≤ 0.0001）。与 TAVI 存活者相比，死亡率的逐年趋势表现为 TAVI 手术数量和死亡率的绝对数量增加，但在 2012 年首次达到高峰后，死亡率的年增长率呈下降趋势。需要血液透析的肾衰竭、ST 段抬高型心肌梗死、心源性休克、感染性心内膜炎、肝病和肺炎的患者在接受 TAVI 后住院死亡率更高。
