经导管主动脉瓣置换术后非计划性经皮冠状动脉介入治疗的长期风险。
Long-term risk of unplanned percutaneous coronary intervention after transcatheter aortic valve replacement.
机构信息
Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
CTU, University of Bern, Bern, Switzerland.
出版信息
EuroIntervention. 2022 Nov 18;18(10):797-803. doi: 10.4244/EIJ-D-22-00342.
BACKGROUND
Coronary access after transcatheter aortic valve replacement (TAVR) can be challenging and complicate percutaneous coronary intervention (PCI).
AIMS
We aimed to investigate the incidence, characteristics, and predictors of unplanned PCI after TAVR.
METHODS
In a single-centre registry, TAVR candidates were systematically screened for concomitant coronary artery disease (CAD) through the use of coronary angiography prior to TAVR. Rates of unplanned PCI were prospectively collected and independently adjudicated.
RESULTS
Among 3,015 patients undergoing TAVR between August 2007 and December 2020, 67 patients (2.2%) underwent unplanned PCI after TAVR. The indication for unplanned PCI was acute coronary syndrome in more than half of the cases. Patients with unplanned PCI were younger (80.2±6.5 years vs 81.9±6.4 years; p=0.028) and more likely to be male (75% vs 50%; p<0.001) than those without unplanned PCI. In a multivariable analysis, the number of diseased vessels, male sex, and younger age were independently associated with an increased risk of unplanned PCI. The cumulative incidence rates of unplanned PCI at 1, 5, and 10 years were 0.1%, 0.4%, and 0.6% in patients with no CAD at the time of TAVR, 0.7%, 2.5%, and 3.4% in patients with single-vessel disease, and 1.5%, 5.4%, and 7.4% in patients with multivessel disease, respectively.
CONCLUSIONS
The lifetime risk of unplanned PCI after TAVR is low in patients with no CAD at the time of TAVR but accumulates over time in patients with known CAD, particularly multivessel disease.
CLINICALTRIALS
gov: NCT01368250.
背景
经导管主动脉瓣置换术（TAVR）后的冠状动脉入路可能具有挑战性，并使经皮冠状动脉介入治疗（PCI）复杂化。
目的
我们旨在研究 TAVR 后计划外 PCI 的发生率、特征和预测因素。
方法
在单中心注册中，通过 TAVR 前进行冠状动脉造影，对 TAVR 候选者进行系统筛查，以确定是否存在并存的冠状动脉疾病（CAD）。前瞻性收集并独立裁决计划外 PCI 的发生率。
结果
在 2007 年 8 月至 2020 年 12 月期间接受 TAVR 的 3015 例患者中，有 67 例（2.2%）在 TAVR 后进行了计划外 PCI。计划外 PCI 的指征超过一半为急性冠状动脉综合征。与未进行计划外 PCI 的患者相比，进行计划外 PCI 的患者年龄更小（80.2±6.5 岁 vs 81.9±6.4 岁；p=0.028），且更可能为男性（75% vs 50%；p<0.001）。多变量分析显示，病变血管数量、男性和年龄较小与计划外 PCI 的风险增加独立相关。在 TAVR 时无 CAD 的患者中，计划外 PCI 的 1 年、5 年和 10 年累积发生率分别为 0.1%、0.4%和 0.6%；单支病变患者分别为 0.7%、2.5%和 3.4%；多支病变患者分别为 1.5%、5.4%和 7.4%。
结论
在 TAVR 时无 CAD 的患者中，TAVR 后计划外 PCI 的终生风险较低，但在已知 CAD 患者中会随时间累积，尤其是多支病变患者。
临床试验
gov：NCT01368250。
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