Miyawaki Norihisa, Ishizu Kenichi, Shirai Shinichi, Miyahara Katsunori, Yamamoto Ko, Suenaga Tomohiro, Otani Akira, Nakano Kenji, Fukushima Tadatomo, Ko Euihong, Tsuru Yasuo, Nakamura Miho, Morofuji Toru, Morinaga Takashi, Hayashi Masaomi, Isotani Akihiro, Ohno Nobuhisa, Kakumoto Shinichi, Ando Kenji
Department of Cardiology, Kokura Memorial Hospital Kitakyushu Japan.
Department of Cardiovascular Surgery, Kokura Memorial Hospital Kitakyushu Japan.
Circ Rep. 2024 Aug 6;6(9):357-365. doi: 10.1253/circrep.CR-24-0078. eCollection 2024 Sep 10.
Cognitive impairment assessed using the Mini-Mental Status Examination (MMSE) is associated with short-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of cognitive impairment in patients with severe aortic stenosis post-TAVI.
We enrolled 1,057 consecutive patients who underwent TAVI at the Kokura Memorial Hospital and prospectively assessed them using the MMSE. Results showed that 319 (30%) patients had cognitive impairment. Compared with normal cognition, cognitive impairment was associated with an increased risk for 5-year all-cause mortality (55% vs. 39%; P<0.001), cardiovascular mortality (23% vs. 14%; P=0.007), and non-cardiovascular mortality (42% vs. 29%; P<0.001). Multivariable analysis showed that cognitive impairment was independently associated with all-cause mortality (adjusted hazard ratio [aHR] 1.37; 95% confidence interval [CI] 1.10-1.70; P=0.005), and this result was consistent regardless of stratification based on age, sex, body mass index, left ventricular ejection fraction and clinical frailty scale without significant interaction. Patients with MMSE scores <16 had a significantly higher mortality rate compared with patients with MMSE scores >25, 21-25, and 16-20, respectively.
Cognitive impairment assessed using MMSE scores is independently associated with an increased risk for 5-year all-cause mortality in patients undergoing TAVI.
使用简易精神状态检查表（MMSE）评估的认知障碍与经导管主动脉瓣植入术（TAVI）后的短期死亡率相关。我们评估了TAVI术后严重主动脉瓣狭窄患者认知障碍的长期预后影响。
我们纳入了小仓纪念医院连续接受TAVI的1057例患者，并使用MMSE对他们进行前瞻性评估。结果显示，319例（30%）患者存在认知障碍。与认知正常者相比，认知障碍与5年全因死亡率增加相关（55%对39%；P<0.001）、心血管死亡率增加相关（23%对14%；P=0.007）以及非心血管死亡率增加相关（42%对29%；P<0.001）。多变量分析显示，认知障碍与全因死亡率独立相关（调整后风险比[aHR]1.37；95%置信区间[CI]1.10-1.70；P=0.005），无论根据年龄、性别、体重指数、左心室射血分数和临床衰弱量表进行分层，该结果均一致，且无显著交互作用。MMSE评分<16的患者与MMSE评分>25、21-25和16-20的患者相比，死亡率显著更高。
使用MMSE评分评估的认知障碍与接受TAVI患者5年全因死亡率增加独立相关。
