Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland.
Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland; University Heart Center, Zurich, Switzerland.
JACC Cardiovasc Interv. 2021 May 10;14(9):952-960. doi: 10.1016/j.jcin.2021.01.042. Epub 2021 Apr 14.
The aim of this study was to investigate age-related outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) as assessed in a nationwide, prospective, multicenter cohort study.
TAVR is the preferred treatment for elderly patients with severe aortic stenosis and is expanding into lower age groups.
Data from the SwissTAVI Registry were analyzed. Clinical outcomes were compared between patients 70 years of age or younger (n = 324), 70 to 79 years of age (n = 1,913), 80 to 89 years of age (n = 4,353), and older than 90 years of age (n = 507). Observed deaths were correlated with expected deaths in the general Swiss population using standardized mortality ratios.
Between February 2011 and June 2018, 7,097 patients (mean age 82.0 ± 6.4 years, 49.6% women) underwent TAVR at 15 hospitals in Switzerland. Procedural characteristics were similar; however, older patients more often had discharge to the referring hospital or a rehabilitation facility after TAVR. Using adjusted analyses, a linear trend for mortality (30-day adjusted hazard ratio [HR]: 1.45; 95% confidence interval [CI]: 1.18 to 1.77; 1-year HR: 1.12; 95% CI: 1.01 to 1.24), cerebrovascular accidents (30-day HR: 1.35; 95% CI: 1.09 to 1.66; 1-year HR: 1.21; 95% CI: 1.02 to 1.45), and pacemaker implantation (30-day HR: 1.23; 95% CI: 1.12 to 1.34; 1-year HR: 1.19; 95% CI: 1.09 to 1.30) was observed with increasing age. Furthermore, standardized mortality ratios were 12.63 (95% CI: 9.06 to 17.58), 4.09 (95% CI: 3.56 to 4.74), 1.63 (95% CI: 1.50 to 1.78), and 0.93 (95% CI: 0.76 to 1.14) for TAVR patients in relation to the Swiss population <70, 70 to 79, 80 to 89 and ≥90 years of age, respectively.
Increasing age is associated with a linear trend for mortality, stroke, and pacemaker implantation during early and longer-term follow-up after TAVR. Standardized mortality ratios were higher for TAVR patients younger than 90 years of age compared with expected rates of mortality in an age- and sex-matched Swiss population. (SWISS TAVI Registry; NCT01368250).
本研究旨在通过一项全国性、前瞻性、多中心队列研究，调查接受经导管主动脉瓣置换术（TAVR）治疗的患者的年龄相关结局。
TAVR 是治疗严重主动脉瓣狭窄老年患者的首选方法，并且正在扩展到年龄较小的患者群体。
对瑞士 TAVI 注册中心的数据进行分析。将 70 岁或以下（n=324）、70 至 79 岁（n=1913）、80 至 89 岁（n=4353）和 90 岁以上（n=507）的患者的临床结局进行比较。使用标准化死亡率比，将观察到的死亡与瑞士普通人群的预期死亡相关联。
2011 年 2 月至 2018 年 6 月，在瑞士的 15 家医院，共有 7097 名（平均年龄 82.0±6.4 岁，49.6%为女性）患者接受了 TAVR 治疗。手术特点相似；然而，年龄较大的患者在 TAVR 后更常出院到转诊医院或康复设施。使用调整后的分析，死亡率呈线性趋势（30 天调整后的危险比[HR]：1.45；95%置信区间[CI]：1.18 至 1.77；1 年 HR：1.12；95%CI：1.01 至 1.24）、脑血管意外（30 天 HR：1.35；95%CI：1.09 至 1.66；1 年 HR：1.21；95%CI：1.02 至 1.45）和起搏器植入（30 天 HR：1.23；95%CI：1.12 至 1.34；1 年 HR：1.19；95%CI：1.09 至 1.30）与年龄增加呈线性相关。此外，TAVR 患者的标准化死亡率分别为 12.63（95%CI：9.06 至 17.58）、4.09（95%CI：3.56 至 4.74）、1.63（95%CI：1.50 至 1.78）和 0.93（95%CI：0.76 至 1.14），与瑞士<70 岁、70 至 79 岁、80 至 89 岁和≥90 岁的人群相比。
在 TAVR 后的早期和长期随访中，年龄增加与死亡率、中风和起搏器植入呈线性趋势相关。与年龄和性别匹配的瑞士人群的预期死亡率相比，TAVR 患者<90 岁的标准化死亡率较高。（SWISS TAVI 登记处；NCT01368250）。
