Will Maximilian, Schwarz Konstantin, Weiss Thomas, Leibundgut Gregor, Lamm Gudrun, Vock Paul, Mascherbauer Julia, Kwok Chun Shing
Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria.
Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St Poelten, Austria.
Catheter Cardiovasc Interv. 2023 Mar;101(4):806-812. doi: 10.1002/ccd.30601. Epub 2023 Feb 19.
Coronary artery disease (CAD) is frequently encountered in patients evaluated for transcatheter aortic valve replacement (TAVR) due to severe aortic stenosis. The prognostic relevance of chronic total occlusions (CTOs) in this setting is poorly understood. We conducted a search of MEDLINE and EMBASE to identify studies evaluating patients who underwent TAVR and evaluated outcomes depending on the presence of coronary CTOs. Pooled analysis was performed to estimate the rate and risk ratio for mortality. Four studies involving 25,432 patients fulfilled the inclusion criteria. The follow up ranged from in-hospital outcomes to 8-years follow-up. Coronary artery disease was present in 67.8% to 75.5% of patients in 3 studies which reported this variable. The prevalence of CTOs varied between 2% and 12.6% in this cohort. The presence of CTOs was associated with increase in length of stay (8.1 ± 8.2 vs. 5.9 ± 6.5, p < 0.01), cardiogenic shock (5.1% vs. 1.7%, p < 0.01), acute myocardial infarction (5.8% vs. 2.8%, p = 0.02) and acute kidney injury (18.6% vs. 13.9%, p = 0.048). The pooled 1-year death rate revealed 41 deaths in 165 patients in the CTO group and 396 deaths in 1663 patients with no CTO ((24.8%) vs. (23.8%)). The meta-analysis of death with CTO versus no CTO showed a nonsignificant trend toward increased mortality with CTOs (risk ratio 1.11 95% CI 0.90-1.40, I = 0%). Our analysis suggests that concomitant CTO lesions in patients undergoing TAVR are common, and its presence was associated with increased in-hospital complications. However, CTO presence by itself was not associated with increased long-term mortality, only a nonsignificant trend toward an increased risk of death in patients with CTO was found. Further studies are warranted to assess the prognostic relevance of CTO lesion in TAVR patients.
在因严重主动脉瓣狭窄而接受经导管主动脉瓣置换术（TAVR）评估的患者中，冠状动脉疾病（CAD）很常见。在这种情况下，慢性完全闭塞（CTO）的预后相关性尚不清楚。我们检索了MEDLINE和EMBASE，以确定评估接受TAVR的患者并根据冠状动脉CTO的存在情况评估结局的研究。进行汇总分析以估计死亡率和风险比。四项涉及25432例患者的研究符合纳入标准。随访范围从住院结局到8年随访。在报告了这一变量的3项研究中，67.8%至75.5%的患者存在冠状动脉疾病。该队列中CTO的患病率在2%至12.6%之间。CTO的存在与住院时间延长（8.1±8.2天对5.9±6.5天，p<0.01）、心源性休克（5.1%对1.7%，p<0.01）、急性心肌梗死（5.8%对2.8%，p=0.02）和急性肾损伤（18.6%对13.9%，p=0.048）相关。汇总的1年死亡率显示，CTO组165例患者中有41例死亡，无CTO的1663例患者中有396例死亡（（24.8%）对（23.8%））。CTO与无CTO患者死亡的荟萃分析显示，CTO患者死亡率增加的趋势不显著（风险比1.11，95%CI 0.90-1.40，I=0%）。我们的分析表明，接受TAVR的患者中合并CTO病变很常见，其存在与住院并发症增加相关。然而，CTO本身与长期死亡率增加无关，仅发现CTO患者死亡风险增加的趋势不显著。有必要进一步研究以评估CTO病变在TAVR患者中的预后相关性。
