Department of Cardiology Juntendo University Urayasu Hospital Urayasu Japan.
Department of Radiology Jichi Medical University Saitama Medical Center Saitama Japan.
J Am Heart Assoc. 2023 Nov 7;12(21):e030072. doi: 10.1161/JAHA.123.030072. Epub 2023 Oct 27.
Background Data on clinical outcomes after transcatheter aortic valve replacement (TAVR) in specific cancer types or the presence of metastatic disease remain sparse. This study aimed to investigate the impact of active cancer on short-term mortality, complications, and readmission rates after TAVR across different cancer types. Methods and Results The authors assessed the Nationwide Readmissions Database for TAVR cases from 2012 to 2019. Patients were stratified by specific cancer types. Primary outcome was in-hospital mortality. Secondary outcomes included bleeding requiring blood transfusion and readmissions at 30, 90, and 180 days after TAVR. Overall, 122 573 patients undergoing TAVR were included in the analysis, of whom 8013 (6.5%) had active cancer. After adjusting for potential confounders, the presence of active cancer was not associated with increased in-hospital mortality (adjusted odds ratio [aOR], 1.06 [95% CI, 0.89-1.27]; =0.523). However, active cancer was associated with an increased risk of readmission at 30, 90, and 180 days after TAVR and increased risk of bleeding requiring transfusion at 30 days. Active colon and any type of metastatic cancer were individually associated with readmissions at 30, 90, and 180 days after TAVR. At 30 days after TAVR, colon (aOR, 2.51 [95% CI, 1.68-3.76]; <0.001), prostate (aOR, 1.40 [95% CI, 1.05-1.86]; =0.021), and any type of metastatic cancer (aOR, 1.65 [95% CI, 1.23-2.22]; =0.001) were individually associated with an increased risk of bleeding requiring transfusion. Conclusions Patients with active cancer had similar in-hospital mortality after TAVR but higher risk of readmission and bleeding requiring transfusion, the latter depending on certain types of cancer.
背景 经导管主动脉瓣置换术（TAVR）后特定癌症类型或转移性疾病患者的临床结局数据仍然很少。本研究旨在调查不同癌症类型中活动性癌症对 TAVR 后短期死亡率、并发症和再入院率的影响。
方法和结果 作者评估了 2012 年至 2019 年全国再入院数据库中的 TAVR 病例。根据特定癌症类型对患者进行分层。主要结局为院内死亡率。次要结局包括输血需求的出血和 TAVR 后 30、90 和 180 天的再入院。总体而言，纳入分析的 122573 例接受 TAVR 的患者中，有 8013 例（6.5%）患有活动性癌症。在调整潜在混杂因素后，活动性癌症与院内死亡率增加无关（调整后的优势比 [aOR]，1.06 [95%CI，0.89-1.27]；=0.523）。然而，活动性癌症与 TAVR 后 30、90 和 180 天再入院风险增加以及 30 天输血需求出血风险增加相关。活动性结肠癌和任何类型的转移性癌症分别与 TAVR 后 30、90 和 180 天的再入院相关。在 TAVR 后 30 天，结肠癌（aOR，2.51 [95%CI，1.68-3.76]；<0.001）、前列腺癌（aOR，1.40 [95%CI，1.05-1.86]；=0.021）和任何类型的转移性癌症（aOR，1.65 [95%CI，1.23-2.22]；=0.001）与输血需求出血风险增加独立相关。
结论 TAVR 后，患有活动性癌症的患者院内死亡率相似，但再入院和输血需求出血风险更高，后者取决于特定类型的癌症。
