透管大动脉置换与手术后早期中风之间的关联
Chetan P Huded1, E Murat Tuzcu1, Amar Krishnaswamy1
1Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
JAMA
|June 19, 2019
概括
2011年至2017年间,经过过导管大动脉置换 (TAVR) 的中风率保持稳定. 术后中风显著增加了30天的死亡风险,但与双重抗血小板或口服抗凝剂治疗无关.
科学领域:
- 心血管医学
- 干预心脏病学
- 公共卫生
背景情况:
- 减少手术后的中风对于改善跨导管大动脉置换 (TAVR) 的安全性和结果至关重要.
- 了解TAVR中风趋势和风险因素对于优化患者护理至关重要.
研究的目的:
- 评估在美国使用TAVR后的30天中风趋势.
- 评估术后中风与30天死亡率之间的关联.
- 检查医学治疗对30天中风风险的影响.
主要方法:
- 在2011年11月至2017年5月接受TAVR的101,430名患者的回顾性队列研究.
- 对30天中风和短暂性缺血病发作率的分析.
- 考克斯比例危险模型和倾向性得分匹配用于评估死亡率和治疗相关性.
主要成果:
- 整体30天中风发生率为2. 3%,在整个研究期间保持稳定 (P=0. 22).
- 在30天内中风显著增加死亡风险 (HR,6.1;P<.001).
- 双重抗血小板治疗和口服抗凝剂治疗都没有与30天的中风风险降低相关.
结论:
- 在美国,TAVR后30天中风的发病率保持稳定.
- 在TAVR后的中风是30天死亡率的重要独立预测因素.
- 目前的抗血栓治疗似乎没有影响30天的中风风险.
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