Kühne Stephanie Gladys, Patrignani Andrea, Elvinger Sebastien, Wein Bastian, Harmel Eva, Penev Damyan, Owais Tamer, Girdauskas Evaldas, Raake Philip W, Chiarito Mauro, Bongiovanni Dario
Department of Internal Medicine I, Cardiology, University Hospital Augsburg, Augsburg, Germany.
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Open Heart. 2025 Jan 19;12(1):e003110. doi: 10.1136/openhrt-2024-003110.
Cardiogenic shock (CS) induced by severe aortic stenosis (AS) is a life-threatening condition with high mortality. Despite advancements in emergency interventions, the optimal treatment approach remains uncertain.
This study aimed to systematically review and analyse the existing evidence on outcomes of emergency transcatheter aortic valve implantation (eTAVI) and emergency balloon aortic valvuloplasty (eBAV) in CS patients.
A systematic literature review and meta-analysis was performed. The primary endpoint was mortality at 30 days. Secondary endpoints were in-hospital mortality, 1-year mortality, bleeding, major vascular complications, myocardial infarction, stroke, incidence of pacemaker implantation, acute kidney injury and aortic regurgitation.
Seventeen studies were included, totalling 2811 patients. The analysis revealed a 30-day mortality pooled estimated rate for eTAVI of 19% (CI 0.17 - 0.20) and for eBAV 39% (CI 0.32 - 0.46). In-hospital mortality pooled estimated rates were 11% for eTAVI (CI 0.06 - 0.18) and for eBAV 40% (CI 0.28 - 0.54). One-year mortality pooled estimated rates for eTAVI were 29% (CI 0.20 - 0.40) and for eBAV 67% (CI 0.58 - 0.74). Pooled estimated rates of any bleeding were 12% for eTAVI (CI 0.06 - 0.20) and 15% for eBAV (CI 0.10 - 0.21). The rate of major vascular complications for eTAVI was 8% (CI 0.07 - 0.10) and 3% for eBAV (CI 0.0 - 0.23).
This meta-analysis indicates that mortality in CS due to AS remains high despite emergency interventional treatment. These findings offer critical insights for clinical decision-making optimising patient care in this critically ill population.
严重主动脉瓣狭窄（AS）所致的心源性休克（CS）是一种危及生命的疾病，死亡率很高。尽管紧急干预措施有所进展，但最佳治疗方法仍不确定。
本研究旨在系统评价和分析CS患者紧急经导管主动脉瓣植入术（eTAVI）和紧急球囊主动脉瓣成形术（eBAV）结局的现有证据。
进行了系统的文献综述和荟萃分析。主要终点是30天死亡率。次要终点是住院死亡率、1年死亡率、出血、主要血管并发症、心肌梗死、中风、起搏器植入发生率、急性肾损伤和主动脉瓣反流。
纳入17项研究，共2811例患者。分析显示，eTAVI的30天死亡率合并估计率为19%（CI 0.17 - 0.20），eBAV为39%（CI 0.32 - 0.46）。eTAVI的住院死亡率合并估计率为11%（CI 0.06 - 0.18），eBAV为40%（CI 0.28 - 0.54）。eTAVI的1年死亡率合并估计率为29%（CI 0.20 - 0.40），eBAV为为67%（CI 0.58 - 0.74）。任何出血的合并估计率，eTAVI为12%（CI 0.06 - 0.20），eBAV为15%（CI 0.10 - 0.21）。eTAVI的主要血管并发症发生率为8%（CI 0.07 - 0.10），eBAV为3%（CI 0.0 - 0.23）。
这项荟萃分析表明，尽管进行了紧急介入治疗，但AS所致CS的死亡率仍然很高。这些发现为优化这一危重症人群的患者护理的临床决策提供了关键见解。
