在心脏植入式电子设备患者的死亡结果在转导管大动脉置换之前和之后
Luai Madanat1, Elizabeth Seeley2, Ramy Mando3
1Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan.
The American journal of cardiology
|August 13, 2023
概括
使用现有心脏植入式电子设备 (CIED) 的透气管大动脉置换 (TAVR) 患者面临更高的死亡率和心力衰竭再入院. 调整后的生存率显示没有差异,这表明先前存在的疾病影响了结果.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏电生理学 心脏电生理学
背景情况:
- 过导管大动脉置换 (TAVR) 是对大动脉狭窄的常见手术.
- 高度心房阻塞是TAVR已知的并发症,通常需要心脏植入式电子设备 (CIED) 植入.
- 之前存在的CIED对TAVR结果的影响仍然不完全理解.
研究的目的:
- 评估TAVR对先前存在CIED的患者的结果,与接受CIED后TAVR或没有CIED的患者相比.
- 为了确定所有原因死亡率和TAVR后再接收率的预测因素.
主要方法:
- 在2014年12月至2019年12月期间,对366名接受TAVR的患者进行了回顾性分析.
- 患者被分为三组:先前存在的CIED (组1),TAVR后30天内植入的CIED (组2),没有CIED (组3).
- 考克斯的比例危险模型被用来评估所有原因的死亡率;重新接收的后勤回归.
主要成果:
- 与第2组和第3组相比,患有先前存在的CIED (1组) 的患者显示出更高的未经调整的全因死亡率.
- 多变量分析显示,在三个组中,调整后的长期死亡率没有统计学上显著的差异.
- 与2组和3组相比,第一组因充血性心力衰竭的再入院率在1年内显著提高.
- 术前血红蛋白水平≤12 g/dL被确定为所有原因死亡率的独立预测因素.
结论:
- 虽然调整后的长期存活率在不同组中是相似的,但在接受TAVR治疗的已有CIED患者的死亡率和心力衰竭再录取率更高.
- 这种增加的风险似乎与伴随性疾病负担的增加有关,而不是CIED本身.
- 包括血红蛋白水平在内的并发症的手术前评估对于具有现有CIED的TAVR患者的风险分层至关重要.
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