严重大动脉狭窄患者的皮肤冠状动脉干预:对跨导管大动脉置换的含义
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
概括
在患有严重大动脉狭窄症 (AS) 的患者中,皮肤冠状动脉干预 (PCI) 显示出与没有AS的患者相似的短期死亡率. 然而,具有低射出分数或高外科风险得分的患者在PCI后面临30天死亡率的增加.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 在严重的大动脉狭窄 (AS) 中冠状动脉疾病 (CAD) 的管理是复杂的,特别是有过导管大动脉置换 (TAVR) 的可用性.
- 在患有严重AS和CAD的患者中,穿皮冠状动脉干预 (PCI) 的结果尚未得到充分确立.
- 这项研究比较了患有和没有严重AS的患者的短期PCI结果.
研究的目的:
- 为了比较PCI在患有和没有严重大动脉狭窄症的患者的短期结果.
- 确定严重AS患者PCI后死亡的风险因素.
主要方法:
- 从1998年至2008年对PCI数据库的回顾性分析.
- 包括254名患有严重AS的患者和508名没有AS的患者进行PCI.
- 主要终点:PCI后30天死亡率.
主要成果:
- 在PCI后的30天死亡率在患有和没有严重AS的患者之间是相似的 (4.3%与4.7%,P=0.2).
- 患有严重AS和低射出分数 (≤30%) 的患者的30天死亡率显着更高 (5.4%对1.2%,P<0.001).
- 患有严重AS且胸腔外科医生协会 (STS) 评分高的患者 (≥10) 也有更高的30天死亡率 (10.4%与0%,P<0.001).
结论:
- PCI可以安全地在患有严重症状AS和CAD的患者中进行,与对照组相比,短期死亡率没有增加.
- 低射出分数和高STS分数是严重AS患者PCI后30天死亡率的关键预测指标.
- 研究结果为接受PCI的高风险重症AS患者的管理决策提供指导,特别是那些被考虑为TAVR的患者.
更多相关视频
相关概念视频
Mitral Stenosis III: Medical Management
535
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
535
Aortic Regurgitation I: Introduction
1.6K
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
1.6K
Aortic Regurgitation III: Medical Management
598
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
598
Aortic Regurgitation IV: Nursing Management
453
A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
453
Acute Coronary Syndrome I: Introduction
2.1K
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
2.1K
Aneurysm II: Clinical Manifestations and Diagnostic Studies
589
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
589


