Centro Cardiovascular Universitario, Hospital de Clinicas, Universidad de la Republica, Montevideo, Uruguay.
Institute of Clinical Trials and Methodology, University College London, London, United Kingdom.
PLoS One. 2024 Nov 18;19(11):e0312408. doi: 10.1371/journal.pone.0312408. eCollection 2024.
The best aortic prosthesis type in 60-70 year old patients is not established. Our aim was to evaluate the survival in a National cohort of patients between 60-70 years old who required surgical aortic valve replacement for aortic stenosis (SAVR) with either a mechanical (MP) or bioprosthesis (BP) valve.
This is a retrospective study using national data from the Ministry of Health. We included all patients between 60 to 70 years old who underwent SAVR for aortic stenosis in Uruguay from 2011 to 2021. The primary outcome was overall survival according to type of prosthesis used stratified by effect modifiers. The independent effects of gender and use of statins were evaluated.
We included 1196 patients (66±3.0 years old; 39.1% female). Mortality was higher for BP (296, 29.9%%) than MP (36, 17.1%; p<0.001). Median follow-up time was 4.5 years (Interquartile range [IQR] 3.4-6.5). The unadjusted incidence rate ratio was higher for BP (Incidence rate ratio [IRR] = 1.43;95%CI: 0.99, 2.14, p = 0.045). The effect of BP on mortality rate was greater in males (IRR = 1.82;95%CI:1.14,2.92. p interaction = 0.08) and patients who were not taking statins (IRR = 1.97;95%CI:1.14,3.41. p interaction = 0.06). The use of BP was an independent predictor of overall survival in male patients (Hazard ratio [HR] = 1.32;95%CI: 1.68, 1.04. p = 0.021) and in patients who were not taking statins (HR = 2.07;95%CI: 1.17, 3.67. p = 0.013).
The use of BP was associated with worse survival in male patients and patients not taking statins. Gender and statins use should contribute to type of prosthesis decision in the 60-69 age group.
在 60-70 岁的患者中，哪种主动脉假体最好尚未确定。我们的目的是评估在乌拉圭 2011 年至 2021 年期间，60-70 岁因主动脉瓣狭窄（SAVR）需要行主动脉瓣置换术（SAVR）的患者中，使用机械（MP）或生物（BP）瓣膜的患者的生存情况。
这是一项使用卫生部国家数据的回顾性研究。我们纳入了所有 60 至 70 岁之间因主动脉瓣狭窄接受 SAVR 的患者。主要结局是根据使用的假体类型，分层考虑校正变量后患者的总体生存率。评估了性别和使用他汀类药物的独立影响。
我们纳入了 1196 名患者（66±3.0 岁；39.1%为女性）。BP（296 例，29.9%）的死亡率高于 MP（36 例，17.1%；p<0.001）。中位随访时间为 4.5 年（四分位间距[IQR]3.4-6.5）。BP 的未校正发病率比值更高（发病率比值[IRR] = 1.43；95%CI：0.99，2.14，p = 0.045）。BP 对死亡率的影响在男性（IRR = 1.82；95%CI：1.14，2.92. p 交互= 0.08）和未服用他汀类药物的患者中更大（IRR = 1.97；95%CI：1.14，3.41. p 交互= 0.06）。在男性患者（危险比[HR] = 1.32；95%CI：1.68，1.04. p = 0.021）和未服用他汀类药物的患者（HR = 2.07；95%CI：1.17，3.67. p = 0.013）中，BP 的使用是总生存的独立预测因子。
在男性患者和未服用他汀类药物的患者中，BP 的使用与生存质量下降相关。性别和他汀类药物的使用应该有助于在 60-69 岁年龄组中选择假体类型。
