重度の大動脈狭窄の患者における皮膚による冠動脈介入:トランスキャテータ大動脈弁置換への影響
Sachin S Goel1, Shikhar Agarwal, E Murat Tuzcu
1Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, J2-3, 9500 Euclid Ave, Cleveland, OH 44195, USA. kapadis@ccf.org
Circulation
|January 28, 2012
まとめ
重度の大動脈狭窄症 (AS) の患者における皮膚経冠動脈介入 (PCI) は,ASのない患者と同様の短期死亡率を示しています. しかし,低エジェクション分数または高い外科リスクスコアを持つ患者は,PCI後の30日間の死亡率の増加に直面します.
科学分野:
- 心臓病学 心臓病学
- 介入性心臓病学 介入性心臓病学
- 心臓外科手術について
背景:
- 重度の大動脈狭窄 (AS) の冠動脈疾患 (CAD) の管理は複雑であり,特にトランスキャテーテル大動脈弁置換 (TAVR) の可用性があります.
- 重度のASおよびCADの患者における皮膚経冠動脈介入 (PCI) のアウトカムについては,十分に確立されていません.
- この研究では,重度のASと重度のASのない患者の短期PCIアウトカムを比較しています.
研究 の 目的:
- 重度の大動脈狭窄症と重度の大動脈狭窄症のない患者のPCIの短期的なアウトカムを比較する.
- 重度のAS患者のPCI後の死亡のリスク要因を特定する.
主な方法:
- 1998年から2008年までのPCIデータベースの遡及分析.
- 重度のAS患者の254人と,ASのないPCIを受けた508人の患者を含めた.
- 主要エンドポイント:PCI後の30日間の死亡率.
主要な成果:
- PCI後の30日間の死亡率は,重度のASと重度のASのない患者の間で類似していました (4.3%対4.7%,P=0.2).
- 重度のASと低エジェクション分数 (≤30%) の患者は,30日間の死亡率 (5.4%対1.2%,P<0.001) が著しく高かった.
- 重度のASと高いSTSスコア (≥10) を有する患者は,30日間の死亡率も高かった (10.4%対0%,P<0.001).
結論:
- PCIは,重症症状のASおよびCADの患者に安全に実施できるが,対照群と比較して短期死亡率が増加していない.
- 低射出分数と高いSTSスコアは,重症AS患者のPCI後の30日間の死亡率の重要な予測指標です.
- 発見は,PCIを受ける高リスクの重症AS患者,特にTAVRのために検討されている患者に対する管理決定を導く.
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