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经股动脉经导管主动脉瓣植入术治疗的男性与女性患者 1 年死亡率的预测因素。

Predictors of 1-Year Mortality in Men Versus Women Undergoing Transfemoral Transcatheter Aortic Valve Implantation.

机构信息

Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.

Department of Surgery, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.

出版信息

Am J Cardiol. 2023 Jan 1;186:1-4. doi: 10.1016/j.amjcard.2022.10.018. Epub 2022 Nov 2.

Abstract

Although gender-related disparities in intermediate-term outcomes have been reported after transcatheter aortic valve implantation (TAVI), disparate predictors of mortality in men and women who underwent TAVI have not been well studied. This prospective institutional registry study included 297 consecutive patients (153 men, 144 women) who underwent transfemoral TAVI from December 2015 to June 2018 at an academic tertiary medical center. Baseline and clinical characteristics, procedural data, and clinical outcomes at 1 year were recorded. Mortality rates at 1 year were 11.1% and 20.3% in women and men, respectively (p = 0.033). Risk-adjusted mortality was significantly higher in men who underwent TAVI than in women (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.24 to 4.87, p = 0.010). Gender-specific risk-adjusted predictors of 1-year mortality post-TAVI included the presence of atrial fibrillation (OR 4.20, 95% CI 1.31 to 13.46, p = 0.016) and peripheral artery disease (OR 4.64, 95% CI 1.04 to 20.71, p = 0.044) in women and presence of chronic obstructive pulmonary disease (OR 3.14, 95% CI 1.13 to 8.72, p = 0.029), higher serum creatinine (OR 1.57, 95% CI 1.15 to 2.15, p = 0.004), and lower body mass index (OR 0.88, 95% CI 0.80 to 0.97, p = 0.008) in men. In this prospective institutional registry of adults who underwent TAVI, risk-adjusted 1-year mortality is significantly lower in women, and disparate predictors of risk-adjusted 1-year mortality exist in men and women.

摘要

尽管经导管主动脉瓣植入术(TAVI)后报道了与性别相关的中期结果差异,但 TAVI 后男性和女性死亡率的不同预测因素尚未得到很好的研究。这项前瞻性机构注册研究纳入了 2015 年 12 月至 2018 年 6 月在一家学术三级医疗中心接受经股动脉 TAVI 的 297 例连续患者(153 例男性,144 例女性)。记录了基线和临床特征、程序数据以及 1 年时的临床结局。女性和男性的 1 年死亡率分别为 11.1%和 20.3%(p=0.033)。TAVI 后男性的风险调整死亡率明显高于女性(比值比[OR] 2.45,95%置信区间[CI] 1.24 至 4.87,p=0.010)。TAVI 后 1 年死亡率的性别特异性风险调整预测因素包括女性存在心房颤动(OR 4.20,95%CI 1.31 至 13.46,p=0.016)和外周动脉疾病(OR 4.64,95%CI 1.04 至 20.71,p=0.044),而男性存在慢性阻塞性肺疾病(OR 3.14,95%CI 1.13 至 8.72,p=0.029)、更高的血清肌酐(OR 1.57,95%CI 1.15 至 2.15,p=0.004)和更低的体重指数(OR 0.88,95%CI 0.80 至 0.97,p=0.008)。在这项对接受 TAVI 的成年人进行的前瞻性机构注册研究中,女性的风险调整 1 年死亡率显著降低,并且男性和女性的风险调整 1 年死亡率存在不同的预测因素。

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