Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, USA.
Center for Advanced Analytics and Informatics, Vizient, Irving, Texas, USA.
JACC Cardiovasc Interv. 2024 May 27;17(10):1267-1276. doi: 10.1016/j.jcin.2024.02.026. Epub 2024 Mar 25.
Prior studies have reported decreased use of an invasive approach for acute myocardial infarction (AMI) in patients undergoing transcatheter aortic valve replacement (TAVR).
The aim of this study was to determine whether prior TAVR affects the use of subsequent coronary revascularization and outcomes of AMI in a contemporary national data set.
Consecutive TAVR patients from 2016 to 2022 were identified from the U.S. Vizient Clinical Data Base who were hospitalized after the index TAVR hospitalization with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). Patients with STEMI or NSTEMI with or without prior TAVR from the same time period were compared for the use of coronary angiography, revascularization, and in-hospital outcomes. Propensity score matching was used to account for imbalances in patient characteristics.
Among 206,229 patients who underwent TAVR, the incidence of STEMI was 25 events per 100,000 person-years of follow-up, and that of NSTEMI was 229 events per 100,000 person-years. After propensity matching, the use of coronary revascularization was similar in the prior TAVR and no TAVR cohorts in both the STEMI (65.3% vs 63.9%; P = 0.81) and NSTEMI (41.4% vs 41.7%; P = 0.88) subgroups. Compared with patients without prior TAVR, in-hospital mortality was higher in the prior TAVR cohort in patients with STEMI (27.1% vs 16.7%; P = 0.03) and lower in those with NSTEMI (5.8% vs 8.2%; P = 0.02).
In this large, national retrospective study, AMI events after TAVR were infrequent. There were no differences in the use of coronary revascularization for STEMI or NSTEMI in TAVR patients compared with the non-TAVR population. In-hospital mortality for STEMI is higher in TAVR patients compared with those without prior TAVR.
先前的研究报告称，行经导管主动脉瓣置换术（TAVR）的患者中，急性心肌梗死（AMI）的侵袭性治疗方法的使用率降低。
本研究旨在确定在当代全国数据集中心，先前的 TAVR 是否会影响随后的冠状动脉血运重建以及 AMI 的结局。
从美国 Vizient 临床数据库中确定了 2016 年至 2022 年连续接受 TAVR 的患者，这些患者在 TAVR 住院后的索引住院期间患有 ST 段抬高型心肌梗死（STEMI）或非 ST 段抬高型心肌梗死（NSTEMI）。比较了同一时期具有或不具有先前 TAVR 的 STEMI 或 NSTEMI 患者接受冠状动脉造影、血运重建和住院结局的情况。采用倾向评分匹配来平衡患者特征的不平衡。
在 206229 例接受 TAVR 的患者中，STEMI 的发生率为每 100000 人年随访 25 例，NSTEMI 的发生率为每 100000 人年随访 229 例。经过倾向评分匹配后，在 STEMI（65.3% vs 63.9%；P=0.81）和 NSTEMI（41.4% vs 41.7%；P=0.88）亚组中，先前 TAVR 和无 TAVR 队列中冠状动脉血运重建的使用率相似。与无先前 TAVR 的患者相比，STEMI 患者中先前 TAVR 组的住院死亡率较高（27.1% vs 16.7%；P=0.03），NSTEMI 患者的住院死亡率较低（5.8% vs 8.2%；P=0.02）。
在这项大型的全国性回顾性研究中，TAVR 后发生 AMI 的事件较为罕见。与非 TAVR 人群相比，TAVR 患者在 STEMI 或 NSTEMI 中进行冠状动脉血运重建的使用率没有差异。与无先前 TAVR 的患者相比，TAVR 患者的 STEMI 住院死亡率更高。
