Department of Cardiology, Alfred Hospital, Victoria, Australia.
Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia.
Cardiovasc Revasc Med. 2022 Feb;35:8-15. doi: 10.1016/j.carrev.2021.04.006. Epub 2021 Apr 9.
BACKGROUND/PURPOSE: PPMI and CAD are common in patients undergoing TAVR. Despite several studies evaluating their interaction as well as the influence these factors play on outcomes, there remains no consensus. We sought to evaluate the impact of peri-procedural myocardial injury (PPMI) and incidental coronary artery disease (iCAD) on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).
METHODS/MATERIALS: We analyzed prospective data from 400 patients undergoing TAVI for severe aortic stenosis between 2008 and 2018 to determine rates of PPMI (troponin 15× the upper limit of normal) and iCAD (≥50% stenosis) and their impact on long-term mortality.
Mean age was 83 ± 6 years; 45% were female. PPMI was observed in 65% (254/400). On multivariable logistic regression analysis, higher left ventricular ejection fraction (LVEF) (OR 1.04, 95%CI 1.01-1.06, p = 0.002), and first generation valves (OR 3.00, 95%CI 1.75-5.15, p < 0.001) were independently associated with PPMI, while oral anticoagulation was inversely associated (OR 0.48, 95%CI 0.28-0.82, p = 0.007). PPMI was not associated with 30-day, 1-year or long-term mortality. After excluding previous bypass grafting, iCAD was observed in 40% (129/324). In patients with iCAD, PCI was associated with reduced long-term mortality compared to medical management in adjusted analysis (OR 0.37, 95%CI 0.16-0.88, p = 0.03).
PPMI and iCAD in patients undergoing TAVR are common. PPMI is associated with older generation valves and higher LVEF rather than traditional cardiovascular risk factors. In our study, PPMI was not associated with long-term mortality. However, in patients with iCAD, PCI was associated with reduced long-term mortality compared to medical management.
背景/目的：经导管主动脉瓣置换术（TAVR）患者常同时存在围手术期心肌损伤（PPMI）和偶然发现的冠状动脉疾病（iCAD）。尽管已有多项研究评估了这两种情况的相互作用以及这些因素对结局的影响，但目前仍未达成共识。我们旨在评估经导管主动脉瓣置换术（TAVR）患者围手术期心肌损伤（PPMI）和偶然发现的冠状动脉疾病（iCAD）对结局的影响。
方法/材料：我们分析了 2008 年至 2018 年间 400 例因严重主动脉瓣狭窄而行 TAVI 的患者的前瞻性数据，以确定围手术期心肌损伤（肌钙蛋白 15 倍正常值上限）和偶然发现的冠状动脉疾病（≥50%狭窄）的发生率，并评估其对长期死亡率的影响。
平均年龄为 83±6 岁，45%为女性。65%（254/400）的患者发生 PPMI。多变量逻辑回归分析显示，较高的左心室射血分数（LVEF）（比值比 [OR] 1.04，95%置信区间 [CI] 1.01-1.06，p=0.002）和第一代瓣膜（OR 3.00，95%CI 1.75-5.15，p<0.001）与 PPMI 独立相关，而口服抗凝剂则呈负相关（OR 0.48，95%CI 0.28-0.82，p=0.007）。PPMI 与 30 天、1 年和长期死亡率无关。排除既往旁路移植术后，在 324 例患者中发现 40%（129/324）存在 iCAD。在有 iCAD 的患者中，调整分析显示与药物治疗相比，经皮冠状动脉介入治疗（PCI）与长期死亡率降低相关（比值比 [OR] 0.37，95%CI 0.16-0.88，p=0.03）。
TAVR 患者常同时存在 PPMI 和 iCAD。PPMI 与较老一代瓣膜和较高的 LVEF 相关，而非与传统心血管危险因素相关。在我们的研究中，PPMI 与长期死亡率无关。然而，在有 iCAD 的患者中，与药物治疗相比，PCI 与长期死亡率降低相关。
