跨导管大动脉置换1年后的临床结果
David R Holmes1, J Matthew Brennan2, John S Rumsfeld3
1Mayo Clinic, Rochester, Minnesota.
JAMA
|March 11, 2015
概括
在美国进行过导管大动脉置换 (TAVR) 后的一年结果显示,死亡率为23.7%,中风率为4.1%. 这些发现对于有关TAVR风险和益处的患者讨论至关重要.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在实践中引入新的医疗器械需要了解临床试验之外的真实世界患者的结果.
- 之前的报告集中在30天的结果上;为全面的TAVR评估,一年的数据至关重要.
研究的目的:
- 更新30天的结果,并呈现美国跨导管大动脉置换 (TAVR) 的1年结果.
- 为了评估大量,现实世界的TAVR人群中的死亡率,中风和再住院率.
主要方法:
- 利用了来自STS/ACC跨导管治疗注册表和CMS行政索赔的链接数据.
- 分析了来自299家美国医院的12182名TAVR患者,这些患者从2011年11月到2013年6月接受了手术.
- 使用多变量建模评估1年结果,包括死亡率和中风.
主要成果:
- 患者的中位数年龄为84岁,52%为女性,中位数STS PROM得分为7.1%.
- 一年整体死亡率为23.7%,中风率为4.1%,死亡/中风复合率为26.0%.
- 晚年,男性性别,末期脏病,严重的慢性肺炎,非关接入,较高的STS PROM和心房动与1年死亡率的增加有关.
结论:
- 在美国的临床实践中,TAVR与1年后23.7%的死亡率和4.1%的中风率有关.
- 这些现实世界结果为患者咨询和关于TAVR的共同决策提供了有价值的信息.
- 与男性相比,女性患中风的风险更高.
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