Tan Elise Chia-Hui, Lee Yung-Tsai, Kuo Yu Chen, Tsao Tien-Ping, Lee Kuo-Chen, Hsiung Ming-Chon, Wei Jeng, Lin Kuan-Chia, Yin Wei-Hsian
Department of Health Service Administration, China Medical University, Taichung, Taiwan.
Department of Pharmacy, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Front Cardiovasc Med. 2022 Sep 21;9:973889. doi: 10.3389/fcvm.2022.973889. eCollection 2022.
This study compared transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in terms of short- and long-term effectiveness.
This retrospective cohort study based on nationwide National Health Insurance claims data and Cause of Death data focused on adult patients ( = 3,643) who received SAVR (79%) or TAVR (21%) between 2015 and 2019. Propensity score overlap weighting was applied to account for selection bias. Primary outcomes included all-cause mortality (ACM), hospitalization for heart failure, and a composite endpoint of major adverse cardiac events (MACE). Secondary outcomes included medical utilization, hospital stay, and total medical costs at index admission for the procedure and in various post-procedure periods. The Cox proportional-hazard model with competing risk was used to investigate survival and incidental health outcomes. Generalized estimation equation (GEE) models were used to estimate differences in the utilization of medical resources and overall costs.
After weighting, the mean age of the patients was 77.98 ± 5.86 years in the TAVR group and 77.98 ± 2.55 years in the SAVR group. More than half of the patients were female (53.94%). The incidence of negative outcomes was lower in the TAVR group than in the SAVR group, including 1-year ACM (11.39 vs. 17.98%) and 3-year ACM (15.77 vs. 23.85%). The risk of ACM was lower in the TAVR group (HR [95% CI]: 0.61 [0.44-0.84]; = 0.002) as was the risk of CV death (HR [95% CI]: 0.47 [0.30-0.74]; = 0.001) or MACE (HR [95% CI]: 0.66 [0.46-0.96]; = 0.0274). Total medical costs were significantly higher in the TAVR group than in the SAVR in the first year after the procedure ($1,271.89 ± 4,048.36 vs. $887.20 ± 978.51; = 0.0266); however, costs were similar in the second and third years after the procedure. The cumulative total medical costs after the procedure were significantly higher in the TAVR group than in the SAVR group (adjusted difference: $420.49 ± 176.48; = 0.0172).
In this real-world cohort of patients with aortic stenosis, TAVR proved superior to SAVR in terms of clinical outcomes and survival with comparable medical utilization after the procedure.
本研究比较经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）的短期和长期疗效。
这项基于全国医疗保险索赔数据和死亡原因数据的回顾性队列研究聚焦于2015年至2019年间接受SAVR（79%）或TAVR（21%）的成年患者（n = 3643）。采用倾向得分重叠加权法来消除选择偏倚。主要结局包括全因死亡率（ACM）、因心力衰竭住院以及主要不良心脏事件（MACE）的复合终点。次要结局包括医疗资源利用情况、住院时间以及手术首次入院时和术后不同阶段的总医疗费用。采用具有竞争风险的Cox比例风险模型来研究生存情况和附带的健康结局。使用广义估计方程（GEE）模型来估计医疗资源利用和总体费用的差异。
加权后，TAVR组患者的平均年龄为77.98±5.86岁，SAVR组为77.98±2.55岁。超过一半的患者为女性（53.94%）。TAVR组不良结局的发生率低于SAVR组，包括1年ACM（11.39%对17.98%）和3年ACM（15.77%对23.85%）。TAVR组的ACM风险较低（HR[95%CI]：0.61[0.44 - 0.84]；P = 0.002），心血管死亡风险（HR[95%CI]：0.47[0.30 - 0.74]；P = 0.001）或MACE风险（HR[95%CI]：0.66[0.46 - 0.96]；P = 0.0274）也较低。术后第一年，TAVR组的总医疗费用显著高于SAVR组（1271.89±4048.36美元对887.20±978.51美元；P = 0.0266）；然而，术后第二年和第三年费用相似。术后TAVR组的累计总医疗费用显著高于SAVR组（调整差异：420.49±176.48美元；P = 0.0172）。
在这个主动脉瓣狭窄患者的真实世界队列中，TAVR在临床结局和生存方面优于SAVR，且术后医疗资源利用相当。
