慢性类固醇治疗患者行经导管主动脉瓣置换术后的血管并发症和结局：荟萃分析。

Vascular complications and outcomes following transcatheter aortic valve replacement in patients on chronic steroid therapy: a meta-analysis.

机构信息

Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA.

Department of Medicine, International Medical University, Malaysia.

出版信息

Int J Surg. 2024 Apr 1;110(4):2421-2429. doi: 10.1097/JS9.0000000000001132.

DOI:10.1097/JS9.0000000000001132

PMID:38320107

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11020145/

Abstract

BACKGROUND

Chronic steroid (CS) therapy was reportedly linked to increased vascular complications following percutaneous coronary intervention. However, its association with vascular complications after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported.

OBJECTIVE

The authors aimed to compare the rate of vascular complications and outcomes between patients with and without CS use after TAVR.

METHODS

The authors conducted a comprehensive literature search in PubMed, Embase, and Cochrane databases from their inception until 18th April 2022 for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions. Effect sizes were pooled using DerSimonian and Laird random-effects model as risk ratio (RR) with 95% CI.

RESULTS

Five studies with 6136 patients undergoing TAVR were included in the analysis. The included studies were published between 2015 and 2022. The mean ages of patients in both study groups were similar, with the CS group averaging 80 years and the nonsteroid group averaging 82 years. Notably, a higher proportion of patients in the CS group were female (56%) compared to the nonsteroid group (54%). CS use was associated with a significantly higher risk of major vascular complications (12.5 vs. 6.7%, RR 2.32, 95% CI: 1.73-3.11, P <0.001), major bleeding (16.8 vs. 13.1%, RR 1.61, 95% CI: 1.27-2.05, P <0.001), and aortic annulus rupture (2.3 vs. 0.6%, RR 4.66, 95% CI: 1.67-13.01, P <0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI: 1.00-2.04, P =0.05), in-hospital mortality (2.3 vs. 1.4%, RR 1.86, 95% CI: 0.74-4.70, P =0.19), and 30-day mortality (2.9 vs. 3.1%, RR 1.14, 95% CI: 0.53-2.46, P =0.74) between both groups.

CONCLUSION

Our study showed that CS therapy is associated with increased major vascular complications, major bleeding, and annulus rupture following TAVR. Further large multicenter studies or randomized controlled trials are warranted to validate these findings.

摘要

背景

据报道，慢性类固醇（CS）治疗与经皮冠状动脉介入治疗后血管并发症的增加有关。然而，其与经导管主动脉瓣置换术（TAVR）后血管并发症的关系仍不确定，已有相互矛盾的结果报道。

目的

作者旨在比较 TAVR 后使用 CS 和不使用 CS 的患者之间血管并发症和结局的差异。

方法

作者对 PubMed、Embase 和 Cochrane 数据库进行了全面的文献检索，检索时间截至 2022 年 4 月 18 日，以获取相关研究。根据 Valve Academic Research Consortium-2 定义描述终点。使用 DerSimonian 和 Laird 随机效应模型作为风险比（RR）和 95%置信区间（CI）来汇总效应量。

结果

纳入的分析包括了 5 项研究，共计 6136 例接受 TAVR 的患者。纳入的研究发表于 2015 年至 2022 年期间。两组患者的平均年龄相似，CS 组平均 80 岁，非类固醇组平均 82 岁。值得注意的是，CS 组中女性的比例（56%）明显高于非类固醇组（54%）。CS 使用与主要血管并发症（12.5%比 6.7%，RR 2.32，95%CI：1.73-3.11，P<0.001）、大出血（16.8%比 13.1%，RR 1.61，95%CI：1.27-2.05，P<0.001）和主动脉瓣环破裂（2.3%比 0.6%，RR 4.66，95%CI：1.67-13.01，P<0.001）的风险显著增加相关。两组间次要血管并发症（RR 1.43，95%CI：1.00-2.04，P=0.05）、住院死亡率（2.3%比 1.4%，RR 1.86，95%CI：0.74-4.70，P=0.19）和 30 天死亡率（2.9%比 3.1%，RR 1.14，95%CI：0.53-2.46，P=0.74）无显著差异。