トランスキャセータ性大動脈弁置換と早期の術後脳卒中との関連
Chetan P Huded1, E Murat Tuzcu1, Amar Krishnaswamy1
1Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
JAMA
|June 19, 2019
まとめ
トランスキャテーター大動脈弁置換 (TAVR) の脳卒中率は2011年から2017年の間に安定した. 術後の脳卒中では,30日間の死亡リスクが有意に増加したが,抗血小板剤または経口抗凝固剤の二重療法と関連していなかった.
科学分野:
- 心血管医学
- 介入心臓科
- 公衆衛生
背景:
- 術後の脳卒中を減らすことは,トランスキャテーター大動脈弁置換 (TAVR) の安全性と結果の改善に不可欠です.
- TAVRの後の脳卒中の傾向とリスク要因を理解することは,患者のケアを最適化するために不可欠です.
研究 の 目的:
- TAVRを米国で最初の5年間使用した後の30日間の脳卒中傾向を評価する.
- 術後の脳卒中と30日間の死亡率との関連を評価する.
- 30日間の脳卒中リスクに対する医療療法の影響を調べる.
主な方法:
- 2011年11月から2017年5月にかけてTAVRを受けた101,430人の患者による遡及コホート研究.
- 30日間の脳卒中と 暫定性不血症の発症率の分析
- 死亡率と治療関連性を評価するために,コックス比例リスクモデルと傾向スコアマッチングを使用した.
主要な成果:
- 全体の30日間の脳卒中率は2. 3%であり,研究期間中に安定した割合であった (P=0. 22).
- 30日以内の脳卒中の死亡リスクが著しく増加した (HR,6. 1; P<. 001).
- 二重抗血小板療法も,出院後の経口抗凝固剤療法も,30日間の脳卒中リスクの減少と関連しませんでした.
結論:
- TAVR後の30日間の脳卒中の発生率は米国で安定しています.
- TAVR後の脳卒中は30日間の死亡率の有意な独立した予測因子です.
- 退院時の現在の抗血栓治療は30日間の脳卒中リスクに影響を与えないようです.
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