Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania.
Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania.
Am J Cardiol. 2023 Apr 15;193:126-132. doi: 10.1016/j.amjcard.2023.02.003. Epub 2023 Mar 9.
Acute coronary syndrome (ACS) encompasses a broad category of presentations from unstable angina to ST-elevation myocardial infarctions. Most patients undergo coronary angiography upon presentation for diagnosis and treatment. However, the ACS management strategy after transcatheter aortic valve implantation (TAVI) may be complicated because of challenging coronary access. The National Readmission Database was reviewed to identify all patients who were readmitted with ACS within 90 days after TAVI between 2012 and 2018. Their outcomes were described between patients who were readmitted with ACS (ACS group) and without (non-ACS group). A total of 44,653 patients were readmitted within 90 days after TAVI. Among them, 1,416 patients (3.2%) were readmitted with ACS. The ACS group had a higher prevalence of men, diabetes, hypertension, congestive heart failure, peripheral vascular disease, and a history of percutaneous coronary intervention (PCI). In the ACS group, 101 patients (7.1%) developed cardiogenic shock, whereas 120 patients (8.5%) developed ventricular arrhythmias. Overall, 141 patients (9.9%) in the ACS group died during readmissions (vs 3.0% in the non-ACS group, p <0.001). Among the ACS group, PCI was performed in 33 (5.9%), whereas coronary bypass grafting was performed in 12 (0.82%). The factors associated with ACS readmission included a history of diabetes, congestive heart failure, chronic kidney disease, and PCI, and nonelective TAVI. Coronary artery bypass grafting was an independent factor related to in-hospital mortality during ACS readmission (odds ratio 11.9, 95% confidence interval 2.18 to 65.4, p = 0.004), whereas PCI was not (odds ratio 0.19, 95% confidence interval 0.03 to 1.44, p = 0.11). In conclusion, patients readmitted with ACS have significantly higher mortality compared with those readmitted without ACS. History of PCI is an independent factor associated with ACS after TAVI.
急性冠状动脉综合征（ACS）包括从不稳定型心绞痛到 ST 段抬高型心肌梗死等多种临床表现。大多数患者在就诊时会接受冠状动脉造影以明确诊断并制定治疗方案。然而，由于经导管主动脉瓣置换术（TAVI）后冠状动脉通路存在挑战，ACS 的管理策略可能会变得复杂。本研究通过回顾 2012 年至 2018 年间全美再入院数据库，以明确 TAVI 后 90 天内因 ACS 再入院的所有患者，并对 ACS 组（再入院时患有 ACS）和非 ACS 组（再入院时未患有 ACS）患者的结局进行了描述。共 44653 例患者在 TAVI 后 90 天内再入院。其中，1416 例（3.2%）患者因 ACS 再入院。ACS 组中男性、糖尿病、高血压、充血性心力衰竭、外周血管疾病和经皮冠状动脉介入治疗（PCI）史的发生率更高。ACS 组中，101 例（7.1%）患者发生心源性休克，120 例（8.5%）患者发生室性心律失常。总体而言，ACS 组中有 141 例（9.9%）患者在再入院期间死亡（而非 ACS 组为 3.0%，p<0.001）。ACS 组中，33 例（5.9%）患者接受了 PCI，12 例（0.82%）患者接受了冠状动脉旁路移植术。与 ACS 再入院相关的因素包括糖尿病、充血性心力衰竭、慢性肾脏病和 PCI 史以及非紧急 TAVI。冠状动脉旁路移植术是 ACS 再入院期间院内死亡的独立相关因素（比值比 11.9，95%置信区间 2.18 至 65.4，p=0.004），而 PCI 则不是（比值比 0.19，95%置信区间 0.03 至 1.44，p=0.11）。总之，与未因 ACS 再入院的患者相比，因 ACS 再入院的患者死亡率显著更高。PCI 史是 TAVI 后发生 ACS 的独立相关因素。
