经导管主动脉瓣植入术后临床结局的预测因素：一项前瞻性队列研究。
Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study.
机构信息
Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
出版信息
Open Heart. 2021 Sep;8(2). doi: 10.1136/openhrt-2021-001766.
OBJECTIVE
In recent years, transcatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with symptomatic aortic valve stenosis considered to be at increased or high surgical risk. The aim of this study was to identify predictors of postoperative adverse events in older adults undergoing TAVI.
METHODS
A prospective observational cohort study of patients who were referred to a geriatric outpatient clinic for a geriatric assessment prior to TAVI was conducted. The outcomes were mortality and hospital readmission within 3 months of TAVI and the occurrence of major postoperative complications during hospitalisation according to the Clavien-Dindo classification. These three outcomes were also combined to a composite outcome. Univariate and multivariate logistic regression analyses were performed to identify predictors of the outcomes and composite outcome of adverse events.
RESULTS
This cohort included 490 patients who underwent TAVI (mean age 80.7±6.2 years, 47.3% male). Within 3 months of TAVI, 19 (3.9%) patients died and 46 (9.4%) patients experienced a hospital readmission. A total of 177 (36.1%) patients experienced one or more major complications according to the Clavien-Dindo classification during hospitalisation and 193 patients (39.4%) experienced the composite outcome of adverse events. In multivariate analyses, cognitive impairment was identified as an independent predictor of major postoperative complications (OR 2.16; 95% CI 1.14 to 4.19) and the composite outcome of adverse events (OR 2.40; 95% CI 1.21 to 4.79). No association was found between the other variables and the separate outcomes and composite outcome.
CONCLUSION
Cognitive impairment is associated with postoperative adverse events in older patients undergoing TAVI. Therefore, it is important to screen for cognitive impairment prior to TAVI and it is recommended to include this in current TAVI guidelines.
目的
近年来，经导管主动脉瓣置换术（TAVI）已成为有症状的主动脉瓣狭窄患者的治疗选择，这些患者被认为手术风险增加或很高。本研究的目的是确定接受 TAVI 的老年患者术后不良事件的预测因素。
方法
对接受 TAVI 前在老年门诊进行老年评估的患者进行前瞻性观察队列研究。结果是 TAVI 后 3 个月内的死亡率和医院再入院率以及根据 Clavien-Dindo 分类的住院期间发生的主要术后并发症。这三个结果也被组合成一个复合结果。进行单变量和多变量逻辑回归分析，以确定不良事件的结果和复合结果的预测因素。
结果
该队列包括 490 名接受 TAVI 的患者（平均年龄 80.7±6.2 岁，47.3%为男性）。TAVI 后 3 个月内，19 名（3.9%）患者死亡，46 名（9.4%）患者再次住院。根据 Clavien-Dindo 分类，共有 177 名（36.1%）患者在住院期间发生了 1 种或多种主要并发症，193 名患者（39.4%）发生了不良事件的复合结果。多变量分析表明，认知障碍是术后主要并发症（OR 2.16；95%CI 1.14 至 4.19）和不良事件复合结果（OR 2.40；95%CI 1.21 至 4.79）的独立预测因素。其他变量与单独的结果和复合结果之间没有关联。
结论
认知障碍与接受 TAVI 的老年患者术后不良事件相关。因此，在 TAVI 之前筛查认知障碍很重要，建议将其纳入当前的 TAVI 指南。
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