Delijani David, Li Leo, Rutkin Bruce, Wilson Sean, Kennedy Kevin F, Hartman Alan R, Yu Pey-Jen
Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA.
Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA.
Eur Heart J Qual Care Clin Outcomes. 2023 Feb 28;9(2):135-141. doi: 10.1093/ehjqcco/qcac021.
Usage of transcatheter aortic valve implantation (TAVI) for treatment of severe aortic stenosis is increasing across age groups. However, literature on age-specific TAVI outcomes is lacking. The purpose of this study is to assess the risks of procedural complications, mortality, and readmission in patients undergoing TAVI across different age groups.
The Nationwide Readmissions Database was used to identify 84 017 patients undergoing TAVI from 2016 to 2018. Patients were stratified into four age groups: younger than 70, 70-79, 80-89, and older than 90. Complications, mortality, and readmission rates were compared between groups in a proportional hazards regression model. Risk of post-procedural stroke, acute kidney injury, and pacemaker or implantable cardioverter defibrillator implantation increased with incremental age grouping. Compared with patients younger than 70, patients aged 70-79 had no significant difference in mortality, whereas patients aged 80-89 and older than 90 had an increased mortality risk [odds ratio (OR) 1.39, confidence interval (CI) 1.14-1.70, P = 0.001 and OR 1.68, CI 1.33-2.12, P < 0.001, respectively]. Patients aged 80-89 and older than 90 had increased overall readmission compared with patients younger than 70 (HR 1.09, CI 1.03-1.14, P = 0.001 and HR 1.33, CI 1.25-1.41, P < 0.001, respectively). Cardiac readmissions followed the same trend.
Patients aged 80-89 and older than 90 undergoing TAVI have increased risk of readmission, complications, and mortality compared with patients younger than 70.
经导管主动脉瓣植入术（TAVI）用于治疗严重主动脉瓣狭窄在各年龄组中的应用正在增加。然而，缺乏关于特定年龄TAVI结局的文献。本研究的目的是评估不同年龄组接受TAVI患者的手术并发症、死亡率和再入院风险。
利用全国再入院数据库识别出2016年至2018年期间接受TAVI的84017例患者。患者被分为四个年龄组：70岁以下、70 - 79岁、80 - 89岁和90岁以上。在比例风险回归模型中比较各组间的并发症、死亡率和再入院率。术后中风、急性肾损伤以及起搏器或植入式心律转复除颤器植入的风险随着年龄分组的增加而增加。与70岁以下的患者相比，70 - 79岁的患者死亡率无显著差异，而80 - 89岁和90岁以上的患者死亡风险增加[比值比（OR）1.39，置信区间（CI）1.14 - 1.70，P = 0.001；OR 1.68，CI 1.33 - 2.12，P < 0.001]。与70岁以下的患者相比，80 - 89岁和90岁以上的患者总体再入院率增加（风险比[HR] 1.09，CI 1.03 - 1.14，P = 0.001；HR 1.33，CI 1.25 - 1.41，P < 0.001）。心脏再入院情况遵循相同趋势。
与70岁以下的患者相比，80 - 89岁和90岁以上接受TAVI的患者再入院、并发症和死亡风险增加。
