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经导管主动脉瓣植入术治疗伴严重主动脉瓣狭窄和冠状动脉疾病患者的 5 年随访:单中心经验。

Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience.

机构信息

Department of Radiology, Örebro University Hospital, Örebro, Sweden.

Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

出版信息

Braz J Cardiovasc Surg. 2023 Oct 27;39(1):e20220461. doi: 10.21470/1678-9741-2022-0461.


DOI:10.21470/1678-9741-2022-0461
PMID:37889212
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10610330/
Abstract

INTRODUCTION: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease. METHODS: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint. RESULTS: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found. CONCLUSION: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.

摘要

简介:目前对于经导管主动脉瓣置换术(TAVI)患者合并冠状动脉疾病(CAD)的影响仍存在争议。因此,本研究旨在单中心环境下评估 TAVI 患者合并 CAD 与不合并 CAD 的 5 年结局。

方法:纳入 2009 年至 2019 年间所有行 TAVI 的患者,并根据是否合并 CAD 进行分组。使用 Cox 回归模型,调整年龄、性别、手术年份和合并症等因素后,评估主要终点——5 年全因死亡率。使用交互检验评估与 CAD 合并的合并症。住院期间的并发症为次要终点。

结果:共纳入 176 例合并 CAD 的主动脉瓣狭窄患者和 170 例单纯主动脉瓣狭窄患者。平均随访时间为 2.2±1.6 年。合并 CAD 与不合并 CAD 的 TAVI 患者的调整后 5 年全因死亡率无差异(风险比 1.00,95%置信区间 0.59-1.70,P=0.99)。在 CAD 患者中,肾功能不全、外周动脉疾病或射血分数<50%与更高的 5 年全因死亡率存在显著的交互作用。两组之间的并发症无显著差异。

结论:合并 CAD 与不合并 CAD 的 TAVI 患者的 5 年死亡率无差异。然而,在合并 CAD 且合并肾功能不全、外周动脉疾病或射血分数<50%的患者中,我们发现其 5 年全因死亡率显著升高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/8d97395a020c/bjcvs-39-01-e20220461-g04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/bdbf8e5dd842/bjcvs-39-01-e20220461-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/8c39ec1494a7/bjcvs-39-01-e20220461-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/7642e539fe59/bjcvs-39-01-e20220461-g03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/e4b546f2c332/bjcvs-39-01-e20220461-g05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/b836c333754c/bjcvs-39-01-e20220461-g06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/e7eb38c3c03d/bjcvs-39-01-e20220461-g07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/8d97395a020c/bjcvs-39-01-e20220461-g04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/bdbf8e5dd842/bjcvs-39-01-e20220461-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/8c39ec1494a7/bjcvs-39-01-e20220461-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/7642e539fe59/bjcvs-39-01-e20220461-g03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/e4b546f2c332/bjcvs-39-01-e20220461-g05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/b836c333754c/bjcvs-39-01-e20220461-g06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/e7eb38c3c03d/bjcvs-39-01-e20220461-g07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05ed/10610330/8d97395a020c/bjcvs-39-01-e20220461-g04.jpg

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引用本文的文献

[1]
Trends, Implications, and Outcomes in the Changing Landscape of Cardiac Surgery: Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease.

Braz J Cardiovasc Surg. 2025-2-17

本文引用的文献

[1]
ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter aortic VAlve implantaTION): A Randomized Clinical Trial.

JACC Cardiovasc Interv. 2021-9-27

[2]
The impact of pre-existing peripheral artery disease on transcatheter aortic valve implantation outcomes: A systematic review and meta-analysis.

Catheter Cardiovasc Interv. 2019-5-17

[3]
Prognosis of Severe Asymptomatic Aortic Stenosis With and Without Surgery.

Ann Thorac Surg. 2019-3-21

[4]
Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients.

N Engl J Med. 2019-3-16

[5]
Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients.

N Engl J Med. 2019-3-16

[6]
Relation of Clinical Presentation of Aortic Stenosis and Survival Following Transcatheter Aortic Valve Implantation.

Am J Cardiol. 2018-12-19

[7]
The predictive value of baseline pulmonary hypertension in early and long term cardiac and all-cause mortality after transcatheter aortic valve implantation for patients with severe aortic valve stenosis: A systematic review and meta-analysis.

Cardiovasc Revasc Med. 2018

[8]
Comparison of midterm outcomes of transcatheter aortic valve implantation in patients with and without previous coronary artery bypass grafting.

Heart Vessels. 2018-10

[9]
Predictors of 1-year mortality after transcatheter aortic valve replacement.

J Card Surg. 2018-5

[10]
Reduced Left Ventricular Ejection Fraction in Patients With Aortic Stenosis.

J Am Coll Cardiol. 2018-3-27

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