Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (K.B., A.S.).
Duke Clinical Research Institute, Durham, NC (M.S., A.S.K.).
Circ Cardiovasc Interv. 2023 Dec;16(12):e013578. doi: 10.1161/CIRCINTERVENTIONS.123.013578. Epub 2023 Oct 23.
Atherosclerotic cardiovascular disease is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Polyvascular disease (PVD), defined as involvement of ≥2 vascular beds (VBs), that is, coronary, cerebrovascular, or peripheral, portends a poor prognosis in patients with atherosclerotic cardiovascular disease; however, data on the association of PVD with outcomes of patients undergoing TAVR are limited.
The Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy Registry was analyzed to identify patients who underwent TAVR from November 2011 to March 2022. The exposure of interest was PVD. The primary outcome was all-cause mortality. Secondary outcomes included major vascular complications, major/life-threatening bleeding, myocardial infarction, transient ischemic attack/stroke, and valve- and non-valve-related readmissions. Outcomes were assessed at 30 days and 1 year.
Of 443 790 patients who underwent TAVR, PVD was present in 150 823 (34.0%; 111 425 [25.1%] with 2VB-PVD and 39 398 [8.9%] with 3VB-PVD). On multivariable analysis, PVD was associated with increased all-cause mortality at 1 year (hazard ratio, 1.17 [95% CI, 1.14-1.20]). There was an incremental increase in 1-year mortality with an increasing number of VBs involved (no PVD [reference]; 2VB-PVD: hazard ratio, 1.12 [95% CI, 1.09-1.15]: and 3VB-PVD: hazard ratio, 1.31 [95% CI, 1.26-1.36]). Patients with versus without PVD had higher rates of major vascular complications, major/life-threatening bleeding, transient ischemic attack/stroke, and non-valve-related readmissions at 30 days and 1 year.
PVD is associated with worse outcomes after TAVR, and the risk is highest in patients with 3VB-PVD.
在接受经导管主动脉瓣置换术（TAVR）的严重主动脉瓣狭窄患者中，动脉粥样硬化性心血管疾病的患病率很高。多血管疾病（PVD）定义为≥2 个血管床（VB）受累，即冠状动脉、脑血管或外周血管，在患有动脉粥样硬化性心血管疾病的患者中预示着预后不良；然而，关于 PVD 与 TAVR 患者结局之间的关系的数据有限。
分析胸外科医师学会和美国心脏病学会经导管瓣膜治疗登记处的数据，以确定 2011 年 11 月至 2022 年 3 月期间接受 TAVR 的患者。研究的暴露因素为 PVD。主要结局是全因死亡率。次要结局包括主要血管并发症、主要/危及生命的出血、心肌梗死、短暂性脑缺血发作/中风以及瓣膜和非瓣膜相关再入院。在 30 天和 1 年时评估结局。
在接受 TAVR 的 443790 例患者中，PVD 存在于 150823 例患者中（34.0%；111425 例存在 2VB-PVD，39398 例存在 3VB-PVD）。多变量分析显示，PVD 与 1 年时全因死亡率增加相关（风险比，1.17 [95%CI，1.14-1.20]）。随着受累 VB 数量的增加，1 年死亡率呈递增趋势（无 PVD [参照]；2VB-PVD：风险比，1.12 [95%CI，1.09-1.15]；3VB-PVD：风险比，1.31 [95%CI，1.26-1.36]）。与无 PVD 患者相比，有 PVD 患者在 30 天和 1 年时主要血管并发症、主要/危及生命的出血、短暂性脑缺血发作/中风和非瓣膜相关再入院的发生率更高。
PVD 与 TAVR 后结局较差相关，在 3VB-PVD 患者中风险最高。
