Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
Am Heart J. 2024 Feb;268:53-60. doi: 10.1016/j.ahj.2023.11.003. Epub 2023 Nov 14.
Severe, symptomatic aortic stenosis may cause heart failure, acute myocardial infarction, or syncope; limited data exist on the occurrence of such events before transcatheter aortic valve replacement (TAVR) and their impact on subsequent outcomes. Thus, we investigated the association between a preceding event and outcomes after TAVR.
From 2014 to 2021 all Danish patients who underwent TAVR were included. Preceding events up to 180 days before TAVR were identified. A preceding event was defined as a hospitalization for heart failure, acute myocardial infarction, or syncope. The 1-year risk of all-cause death, and cardiovascular or all-cause hospitalization was compared for patients with versus without a preceding event using Kaplan-Meier, Aalen-Johansen, and in Cox regression analyses adjusted for patient characteristics.
Of 5,851 patients included, 759 (13.0%) had a preceding event. The median age was 81 years in both groups. Male sex and frailty were more prevalent in patients with a preceding event (males: 64.7% vs 55.2%, frailty: 49.6% vs 40.6%). The most common type of preceding event was a hospitalization for heart failure (n = 524). For patients with a preceding event, the 1-year risk of death was 11.7% (95% CI: 9.4%-14.1%) versus 8.0% (95% CI: 7.2%-8.7%) for patients without. The corresponding adjusted hazard ratio (aHR) was 1.29 (95%CI: 1.01-1.64). Mortality was highest for patients with a preceding event of a heart failure admission (1-year risk: 13.5% [95%CI: 10.5%-16.5%]). Comparing patients with a preceding event to those without, the 1-year risk for cardiovascular rehospitalization was 15.0% versus 8.2% (aHR 1.60 [95%CI: 1.29-1.99]) and 57.6% versus 50.6% for all-cause rehospitalization (aHR 1.08 [95%CI: 0.87-1.20]).
A hospitalization for heart failure, myocardial infarction, or syncope prior to TAVR was associated with a poorer prognosis and could represent a group to focus resource management on. Interventions to prevent preceding events and improvements in pre- and post-TAVR optimization of these patients are warranted.
严重的、有症状的主动脉瓣狭窄可导致心力衰竭、急性心肌梗死或晕厥；关于经导管主动脉瓣置换术（TAVR）前发生此类事件及其对后续结局的影响的数据有限。因此，我们研究了 TAVR 前发生的事件与随后结局之间的关系。
纳入 2014 年至 2021 年期间所有接受 TAVR 的丹麦患者。确定 TAVR 前 180 天内发生的事件。事件定义为心力衰竭、急性心肌梗死或晕厥住院。Kaplan-Meier、Aalen-Johansen 和 Cox 回归分析比较了 TAVR 前有事件和无事件患者的 1 年全因死亡风险，以及心血管或全因住院风险，校正了患者特征。
5851 例患者中，759 例（13.0%）有事件。两组的中位年龄均为 81 岁。TAVR 前有事件的患者中男性比例（64.7% vs. 55.2%）和衰弱比例（49.6% vs. 40.6%）更高。最常见的事件类型是心力衰竭住院（n=524）。TAVR 前有事件的患者 1 年死亡率为 11.7%（95%CI：9.4%-14.1%），无事件的患者为 8.0%（95%CI：7.2%-8.7%）。相应的调整后风险比（aHR）为 1.29（95%CI：1.01-1.64）。心力衰竭入院患者的死亡率最高（1 年风险：13.5%[95%CI：10.5%-16.5%]）。与无事件的患者相比，有事件的患者 1 年心血管再住院风险为 15.0%（aHR 1.60[95%CI：1.29-1.99]），全因再住院风险为 57.6%（aHR 1.08[95%CI：0.87-1.20]）。
TAVR 前因心力衰竭、心肌梗死或晕厥住院与预后较差相关，可能代表需要重点管理资源的人群。需要采取干预措施预防事件发生，并改善这些患者 TAVR 前和后的优化。
