冠心病和经皮冠状动脉介入治疗对经导管主动脉瓣植入术的影响。
Impact of Coronary Artery Disease and Percutaneous Coronary Intervention on Transcatheter Aortic Valve Implantation.
机构信息
Department of Cardiology, Rangueil University Hospital, Toulouse, France.
Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh, Lebanon.
出版信息
J Interv Cardiol. 2021 Mar 24;2021:6672400. doi: 10.1155/2021/6672400. eCollection 2021.
INTRODUCTION
The prevalence of coronary artery disease (CAD) detected in preoperative work-up for transcatheter aortic valve implantation (TAVI) is high. Instead, the management of a concomitant CAD remains unclear. We evaluate the impact of CAD and percutaneous coronary intervention (PCI) on TAVI procedures.
MATERIALS AND METHODS
A retrospective study was conducted on 1336 consecutive patients who underwent TAVI in Toulouse University Hospital, Rangueil, France. The studied population was divided into 2 groups: CAD-TAVI group and No CAD-TAVI group. Then, the CAD-TAVI group was segregated into 2 subgroups: PCI-TAVI group and No PCI-TAVI group. In-hospital adverse clinical outcomes were assessed in each group.
RESULTS
Pre-TAVI work-up revealed significant CAD in 36% of 1030 patients eligible for inclusion in the study. The overall prevalence of in-hospital death, stroke, major or life-threatening bleeding, minor bleeding, major vascular complications, minor vascular complications, pacemaker implantation, and acute kidney injury was 2.7%, 2.4%, 2.8%, 3.6%, 3.9%, 7.5%, 12.5%, and 2.7%, respectively. Among the studied population, 55% were admitted to the cardiac care unit. No significant statistical difference was observed between groups. . CAD-TAVI population was not more likely to develop in-hospital adverse clinical outcomes post-TAVI procedure compared to others. Also, no significant difference regarding in-hospital death was observed. In parallel, performing PCI prior to TAVI did not increase the risk of in-hospital death and complications. The difference in terms of the distribution of antithrombotic regimen may explain the higher prevalence of bleeding events in the PCI-TAVI group.
CONCLUSION
This study provides direct clinical relevance useful in daily practice. No negative impact has been attributed to the presence of a concomitant CAD and/or preoperative PCI on the TAVI hospitalization period.
简介
经术前检查发现，行经导管主动脉瓣植入术（TAVI）的患者中，冠状动脉疾病（CAD）的发病率较高。然而，对于同时合并 CAD 的患者，其管理方案仍不明确。本研究旨在评估 CAD 和经皮冠状动脉介入治疗（PCI）对 TAVI 手术的影响。
材料与方法
本研究回顾性分析了 1336 例在法国图卢兹 Rangueil 大学医院接受 TAVI 治疗的连续患者。研究人群分为两组：CAD-TAVI 组和非 CAD-TAVI 组。然后，CAD-TAVI 组进一步分为 PCI-TAVI 组和非 PCI-TAVI 组。评估每组患者的住院期间不良临床结局。
结果
在 1030 例符合研究条件的患者中，36%的患者在 TAVI 术前检查中发现有明显的 CAD。住院期间总死亡率、卒中和主要或危及生命的出血、轻微出血、大血管并发症、小血管并发症、起搏器植入和急性肾损伤的发生率分别为 2.7%、2.4%、2.8%、3.6%、3.9%、7.5%、12.5%和 2.7%。研究人群中，55%的患者被收入心脏监护病房。各组间无显著统计学差异。CAD-TAVI 组患者 TAVI 术后发生住院期间不良临床结局的可能性并不高于其他组。另外，两组间住院期间死亡率也无显著差异。同时，TAVI 术前行 PCI 并不增加住院期间死亡和并发症的风险。PCI-TAVI 组出血事件发生率较高可能与抗栓方案的分布不同有关。
结论
本研究提供了有用的直接临床相关性，对日常实践有指导意义。合并 CAD 及/或术前 PCI 并不会对 TAVI 住院期间产生负面影响。
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