在患有ESRD和心力衰竭的患者中进行大动脉置换,其中减少了射出分数
Eric D Warner1, Joshua Riley1, Mark Liotta1
1Department of Internal Medicine.
The American journal of cardiology
|August 21, 2023
概括
通过导管的大动脉置换 (TAVR) 与医疗管理相比,为末期病 (ESRD) 患者提供了更好的存活率. 虽然TAVR显示出比手术大动脉置换 (SAVR) 更好的短期结果,但SAVR在这个人群中显示出更好的长期存活率.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 干预心脏病学 干预心脏病学
背景情况:
- 过导管大动脉置换 (TAVR) 是大动脉狭窄的标准,但终末期病 (ESRD) 患者的结果不太了解.
- 接受血液透析的ESRD患者经常被排除在最初的TAVR试验之外,从而导致有限的比较数据.
- 之前的注册数据表明,与非透析患者相比,ESRD患者的TAVR死亡率高于非透析患者.
研究的目的:
- 为了比较TAVR的生存结果,外科上风门置换 (SAVR) 和ESRD患者的医疗管理,这些患者患有大动脉狭窄和心力衰竭,减少射出分数 (HFrEF).
- 在这个特定的高风险患者群体中,评估TAVR与SAVR的住院结果和长期存活率.
主要方法:
- 利用美国脏数据系统识别ESRD患者与大动脉狭窄和HFrEF接受TAVR,SAVR,或2012年后的医疗管理.
- 员工倾向得分匹配,以创建可比较的组进行分析.
- 使用卡普兰-梅尔曲线比较生存率.
主要成果:
- 该研究包括7660名患者;1108人接受了TAVR,695人接受了SAVR.
- 在匹配后,TAVR与医疗管理相比,与改善的生存率有关.
- 住院结局有利于TAVR而不是SAVR,死亡率较低,并发症较少.
- TAVR显示出比SAVR更好的早期死亡率,但生存曲线在9个月时交叉,SAVR显示出更好的长期生存率.
结论:
- 对于患有大动脉狭窄和HFrEF的ESRD患者来说,TAVR是一种安全有效的选择,可以改善医疗管理的生存率.
- TAVR和SAVR都是ESRD患者的可行的治疗选择,这些患者患有大动脉狭窄和HFrEF.
- 在这种人群中,TAVR提供了优越的短期结果,而SAVR则提供了更好的长期生存.
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