Takeji Yasuaki, Taniguchi Tomohiko, Morimoto Takeshi, Shirai Shinichi, Kitai Takeshi, Tabata Hiroyuki, Ohno Nobuhisa, Murai Ryosuke, Osakada Kohei, Murata Koichiro, Nakai Masanao, Tsuneyoshi Hiroshi, Tada Tomohisa, Amano Masashi, Watanabe Shin, Shiomi Hiroki, Watanabe Hirotoshi, Yoshikawa Yusuke, Nishikawa Ryusuke, Obayashi Yuki, Yamamoto Ko, Toyofuku Mamoru, Tatsushima Shojiro, Kanamori Norio, Miyake Makoto, Nakayama Hiroyuki, Nagao Kazuya, Izuhara Masayasu, Nakatsuma Kenji, Inoko Moriaki, Fujita Takanari, Kimura Masahiro, Ishii Mitsuru, Usami Shunsuke, Nakazeki Fumiko, Togi Kiyonori, Inuzuka Yasutaka, Ando Kenji, Komiya Tatsuhiko, Ono Koh, Minatoya Kenji, Kimura Takeshi
Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Cardiovasc Interv Ther. 2025 Jan;40(1):152-163. doi: 10.1007/s12928-024-01054-w. Epub 2024 Nov 28.
There was a scarcity of data evaluating variations in treatment approaches and clinical outcomes for severe aortic stenosis (AS) between medical centers with and without availability of transcatheter aortic valve implantation (TAVI). Current study population was 2993 patients with severe AS enrolled in the CURRENT AS Registry-2 (2581 patients from 10 TAVI centers; 412 patients from 10 non-TAVI centers). TAVI centers more frequently opted for the initial aortic valve replacement (AVR) strategy compared to non-TAVI centers (60% and 40%, P < 0.001). Among patients with the initial AVR strategy, TAVI centers disproportionately favored the initial TAVI strategy compared to non-TAVI centers (71% and 23%, P < 0.001). No significant differences were observed in the risk of a composite of all-cause death or heart failure hospitalization between TAVI and non-TAVI centers in the entire study population (cumulative 3-year incidence: 32.0% and 31.0%, P = 0.37; adjusted hazard ratios: 0.92, 95% confidence intervals: 0.74-1.15, P = 0.45) or in conservative, initial AVR, initial surgical AVR, and initial TAVI strata. A substantial disparity exists in the treatment strategies for patients with severe AS between TAVI and non-TAVI centers. TAVI centers tended to perform AVR, particularly TAVI, earlier and more frequently. However, there was no discernible distinction in the risk of the composite of all-cause death or HF hospitalization between TAVI and non-TAVI centers. UMINID: UMIN000034169.
对于具备和不具备经导管主动脉瓣植入术（TAVI）的医疗中心而言，评估重度主动脉瓣狭窄（AS）治疗方法和临床结果差异的数据较为匮乏。当前的研究人群为2993例纳入CURRENT AS Registry-2的重度AS患者（10个TAVI中心的2581例患者；10个非TAVI中心的412例患者）。与非TAVI中心相比，TAVI中心更常选择初始主动脉瓣置换（AVR）策略（分别为60%和40%，P<0.001）。在采用初始AVR策略的患者中，与非TAVI中心相比，TAVI中心更倾向于初始TAVI策略（分别为71%和23%，P<0.001）。在整个研究人群中，TAVI中心和非TAVI中心在全因死亡或心力衰竭住院复合风险方面未观察到显著差异（3年累积发生率：32.0%和31.0%，P=0.37；调整后风险比：0.92，95%置信区间：0.74-1.15，P=0.45），在保守治疗、初始AVR、初始外科AVR和初始TAVI亚组中也是如此。TAVI中心和非TAVI中心在重度AS患者的治疗策略上存在很大差异。TAVI中心倾向于更早、更频繁地进行AVR，尤其是TAVI。然而，TAVI中心和非TAVI中心在全因死亡或心力衰竭住院复合风险方面没有明显差异。UMIN ID：UMIN000034169。
