Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France.
Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France.
Arch Cardiovasc Dis. 2023 Nov;116(11):506-513. doi: 10.1016/j.acvd.2023.08.001. Epub 2023 Sep 12.
Cardiovascular disease and cancer are the two leading causes of mortality worldwide, and their association presents a therapeutic challenge. Current data regarding the prognosis of active cancer in patients undergoing transcatheter aortic valve replacement are conflicting.
To determine the impact and prognosis of active cancer in transcatheter aortic valve replacement.
All consecutive patients with severe aortic stenosis treated by transcatheter aortic valve replacement between February 2010 and May 2019 were enrolled in a prospective study. The cohort was divided according to the presence or absence of active cancer at baseline. The primary endpoint was all-cause mortality 1 year after the procedure.
A total of 1,125 patients were enrolled: 1,037 (92.2%) without and 88 (7.8%) with active cancer. The most frequent cancers were haematological (36.4%), breast (14.8%) and prostate (14.8%), with 79.5% of patients receiving curative treatment and 17.0% receiving palliative treatment. The 1-year mortality rate was higher in patients with active cancer (27.3% vs. 13.9%; P<0.01), mainly driven by non-cardiovascular causes. An increased cardiovascular mortality rate at 2 years was seen in patients with active cancer (27.5% vs. 15.0%; P=0.03) compared with a similar rate at 1-year follow-up. Active cancer was a strong predictor of 1-year all-cause mortality (hazard ratio 2.46, 95% confidence interval 1.19-4.68; P=0.02). Major/life-threatening bleeding events at 1 year were more frequent in patients with active cancer (P=0.02).
Among patients who undergo transcatheter aortic valve replacement, 1-year all-cause mortality is higher in those with active cancer. We also observed a trend towards increased long-term bleeding events in case of active cancer.
心血管疾病和癌症是全球导致死亡的两大主要原因，它们的同时存在给治疗带来了挑战。目前关于接受经导管主动脉瓣置换术的患者中活动性癌症的预后的数据存在矛盾。
确定活动性癌症对经导管主动脉瓣置换术的影响和预后。
连续纳入 2010 年 2 月至 2019 年 5 月期间接受经导管主动脉瓣置换术治疗的所有严重主动脉瓣狭窄患者，前瞻性研究。根据基线时是否存在活动性癌症，将队列分为两组。主要终点是术后 1 年的全因死亡率。
共纳入 1125 例患者：1037 例（92.2%）无活动性癌症，88 例（7.8%）有活动性癌症。最常见的癌症是血液系统（36.4%）、乳腺（14.8%）和前列腺（14.8%），其中 79.5%的患者接受了根治性治疗，17.0%接受了姑息性治疗。有活动性癌症的患者 1 年死亡率更高（27.3% vs. 13.9%；P<0.01），主要由非心血管原因引起。与 1 年随访时相似，有活动性癌症的患者在 2 年时心血管死亡率更高（27.5% vs. 15.0%；P=0.03）。有活动性癌症是 1 年全因死亡率的强预测因子（风险比 2.46，95%置信区间 1.19-4.68；P=0.02）。有活动性癌症的患者在 1 年时主要/危及生命的出血事件更常见（P=0.02）。
在接受经导管主动脉瓣置换术的患者中，有活动性癌症的患者 1 年全因死亡率更高。我们还观察到在有活动性癌症的情况下，长期出血事件的发生率有增加的趋势。
