Cardiovascular Research Foundation, New York, New York.
Division of Cardiac Surgery, Northwestern University, Chicago, Illinois.
Am J Cardiol. 2021 Jun 1;148:116-123. doi: 10.1016/j.amjcard.2021.02.040. Epub 2021 Mar 7.
The prognostic impact of preexisting atrial fibrillation or flutter (AF) in low-risk patients with severe aortic stenosis treated with transcatheter (TAVR) or surgical aortic valve replacement (SAVR) remains unknown. In this sub-analysis of the PARTNER 3 trial of patients with severe aortic stenosis at low surgical risk randomized 1:1 to TAVR versus SAVR, clinical outcomes were analyzed at 2 years according to AF status. Among 948 patients included in the analysis (452 [47.7%] in the SAVR vs 496 [52.3%] in the TAVR arm), 168 (17.6%) patients had AF [88/452 (19.5%) and 80/496 (16.1%) treated with SAVR and TAVR, respectively]. At 2 years, patients with AF had higher unadjusted rates of the composite outcome of death, stroke or rehospitalization (21.2% vs 12.9%, p = 0.007) and rehospitalization alone (15.3% vs 9.4%, p = 0.03) but not all cause death (3.8% vs 2.6%, p = 0.45) or stroke (4.8% vs 2.6%, p = 0.12). In adjusted analyses, patients with AF had a higher risk for the composite outcome of death, stroke or rehospitalization (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.20-2.71, p = 0.0046) and rehospitalization alone (HR 1.8, 95% CI 0.12-2.9, p = 0.015), but not death or stroke. There was no interaction between treatment modality and AF on the composite outcome (Pinter = 0.83). In conclusion, preexisting AF in patients with severe AS at low surgical risk was associated with increased risk of the composite outcome of death, stroke or rehospitalization at 2 years, irrespective of treatment modality.
在接受经导管（TAVR）或外科主动脉瓣置换术（SAVR）治疗的低危重度主动脉瓣狭窄患者中，预先存在的心房颤动或扑动（AF）的预后影响尚不清楚。在这项低手术风险重度主动脉瓣狭窄患者的 PARTNER 3 试验的亚分析中，患者以 1:1 的比例随机分为 TAVR 与 SAVR 治疗组，根据 AF 状态分析了 2 年的临床结局。在纳入分析的 948 例患者中（SAVR 组 452 例[47.7%]，TAVR 组 496 例[52.3%]），168 例（17.6%）患者患有 AF[分别为 SAVR 组 88/452（19.5%）和 TAVR 组 80/496（16.1%）]。2 年时，AF 患者的复合终点（死亡、卒中和再住院）发生率未校正率较高（21.2% vs 12.9%，p=0.007），再住院率也较高（15.3% vs 9.4%，p=0.03），但全因死亡率（3.8% vs 2.6%，p=0.45）或卒中发生率（4.8% vs 2.6%，p=0.12）无差异。在调整分析中，AF 患者死亡、卒中和再住院的复合终点风险更高（风险比[HR]1.80，95%置信区间[CI]1.20-2.71，p=0.0046）和再住院风险更高（HR 1.8，95%CI 0.12-2.9，p=0.015），但死亡或卒中的风险没有增加。治疗方式与 AF 对复合终点的交互作用无统计学意义（Pinter=0.83）。总之，低手术风险重度主动脉瓣狭窄患者中预先存在的 AF 与 2 年内死亡、卒中和再住院的复合终点风险增加相关，与治疗方式无关。
