Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
Am J Cardiol. 2023 Nov 15;207:202-205. doi: 10.1016/j.amjcard.2023.08.114. Epub 2023 Sep 24.
Peripheral arterial disease (PAD) is common in patients with symptomatic aortic stenosis. PAD exists as a spectrum, and patients with chronic limb-threatening ischemia (CLTI), the most severe form of PAD, are at high risk for limb loss and death. We seek to determine patient characteristics and clinical outcomes among patients who underwent TAVR with or without CLTI. We identified all hospitalizations for TAVR from October 2015 to December 2018 using the National Inpatient Sample database. Patients with any diagnosis of CLTI were identified using the International Classification of Diseases 10th Revision codes. The primary outcome was in-hospital mortality, and secondary outcomes were major complications, open revascularization, and endovascular revascularization after TAVR. During the study period, a total of 31,335 hospitalizations for TAVR procedures were included, including 7,048 (22.5%) in patients with CLTI. CLTI was associated with higher in-hospital mortality (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.13 to 1.74, p = 0.002) and major complications (OR 1.2, 95% CI 1.09 to 1.25, p <0.001). CLTI was also associated with a significantly higher rate of open limb revascularization (OR 5.1, 95% CI 3.94 to 6.48, p <0.001) and endovascular revascularization (OR 4.0, 95% CI 3.54 to 4.59, p <0.001). CLTI among patients who underwent TAVR is associated with higher in-hospital mortality, major complications, and longer lengths of stay compared with patients without CLTI. However, the overall rates of adverse events remain low. Further studies are needed to optimize the multidisciplinary care of these patients before TAVR with a focus on shared decision-making.
外周动脉疾病（PAD）在有症状的主动脉瓣狭窄患者中很常见。PAD 存在于一个谱系中，患有慢性肢体威胁性缺血（CLTI）的患者，这是 PAD 最严重的形式，有肢体丧失和死亡的高风险。我们试图确定接受 TAVR 治疗的患者中是否存在 CLTI 及其临床结局。我们使用国家住院患者样本数据库从 2015 年 10 月至 2018 年 12 月确定了所有接受 TAVR 治疗的住院患者。使用国际疾病分类第 10 次修订版的代码确定任何 CLTI 诊断的患者。主要结局是住院死亡率，次要结局是 TAVR 后主要并发症、开放血管重建术和血管内血管重建术。在研究期间，共纳入 31335 例 TAVR 手术住院患者，其中 7048 例（22.5%）患者存在 CLTI。CLTI 与更高的住院死亡率（比值比 [OR] 1.4，95%置信区间 [CI] 1.13 至 1.74，p=0.002）和主要并发症（OR 1.2，95% CI 1.09 至 1.25，p<0.001）相关。CLTI 还与开放肢体血运重建术（OR 5.1，95% CI 3.94 至 6.48，p<0.001）和血管内血管重建术（OR 4.0，95% CI 3.54 至 4.59，p<0.001）的发生率显著升高相关。与无 CLTI 的患者相比，接受 TAVR 治疗的患者中存在 CLTI 与更高的住院死亡率、主要并发症和更长的住院时间相关。然而，不良事件的总体发生率仍然较低。需要进一步的研究来优化 TAVR 前这些患者的多学科治疗，重点是共同决策。
