经导管主动脉瓣植入术患者的血压与临床结局之间的关联
The Association between Blood Pressure and Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation.
作者信息
Goldberg Idan, Landes Uri, Drozdinsky Genady, Codner Pablo, Bental Tamir, Orvin Katia, Schamroth Pravda Nili, Goldberg Lotem, Soudry Omri, Lerman Tsahi T, Kornowski Ran, Eisen Alon, Vaknin-Assa Hana
机构信息
Department of Internal Medicine F - Recanati, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel.
School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
出版信息
Pulse (Basel). 2024 Jul 22;12(1):85-94. doi: 10.1159/000540209. eCollection 2024 Jan-Dec.
INTRODUCTION
Transcatheter aortic valve implantation (TAVI) has emerged as a common and effective treatment for patients with severe aortic stenosis. Changes in systemic blood pressure after TAVI have been described, yet their prognostic value is not established. Thus, we aimed to examine the association of the periprocedural changes in systolic blood pressure (SBP) and in pulse pressure on clinical outcomes after the procedure.
METHODS
A retrospective study of consecutive patients who underwent TAVI procedure in our medical center. We assessed the effect of the periprocedural changes in blood pressure measurements on mortality, acute myocardial infarction, stroke and hospitalizations at 1 year and on the combined outcome of death, myocardial infarction, and stroke 1 year following the procedure.
RESULTS
Our cohort included 455 patients (44% males). Of them, 343 patients (75.4%) had raised SBP immediately after the procedure. Patients with raised SBP had a significantly higher rate of the 1-year composite outcome, compared to patients who did not have a raise in SBP following the procedure (43 [13%] vs. 6 [5.4%], respectively, = 0.033). After adjustment for age and sex, the postprocedural increase in SBP was significantly associated with the composite outcome, with a hazard ratio of 2.42, 95% CI: 1.03-5.7.
CONCLUSION
An immediate increase in SBP after TAVI is associated with worse 1-year clinical cardiovascular outcomes.
引言
经导管主动脉瓣植入术（TAVI）已成为重度主动脉瓣狭窄患者常用且有效的治疗方法。TAVI术后全身血压的变化已有相关描述，但其预后价值尚未明确。因此，我们旨在研究围手术期收缩压（SBP）和脉压变化与术后临床结局之间的关联。
方法
对在我们医疗中心连续接受TAVI手术的患者进行回顾性研究。我们评估了围手术期血压测量变化对1年死亡率、急性心肌梗死、中风和住院情况的影响，以及对术后1年死亡、心肌梗死和中风综合结局的影响。
结果
我们的队列包括455例患者（44%为男性）。其中，343例患者（75.4%）术后即刻SBP升高。与术后SBP未升高的患者相比，SBP升高的患者1年综合结局发生率显著更高（分别为43例[13%]和6例[5.4%]，P = 0.033）。在调整年龄和性别后，术后SBP升高与综合结局显著相关，风险比为2.42，95%置信区间：1.03 - 5.7。
结论
TAVI术后SBP即刻升高与1年临床心血管结局较差相关。
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