冠状动脉疾病及其在TAVI治疗中的治疗
Pedro Custódio1, Sérgio Madeira2, Rui Teles2
1Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.
概括
阻塞性冠状动脉疾病 (CAD) 的存在及其治疗不会影响通过导管的大动脉干预 (TAVI) 后的存活率. 然而,复杂的冠状动脉病变与TAVI后的生存率下降有关.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血管医学 血管医学
背景情况:
- 大动脉狭窄 (AS) 和冠状动脉疾病 (CAD) 经常同时存在.
- 对于跨导管大动脉干预 (TAVI) 候选人中CAD的最佳手术前评估和再血管化策略仍在争论中.
- 了解CAD对TAVI结果的影响对于患者管理至关重要.
研究的目的:
- 为了确定TAVI候选人中CAD的流行率和血管学特征.
- 为了评估这个患者群体的复血管化模式.
- 评估CAD存在,复杂性和皮肤冠状动脉干预 (PCI) 对TAVI后预后的影响.
主要方法:
- 一项单一中心的回顾性研究分析了从前性收集的TAVI患者 (2009-2018) 登记册中收集的数据.
- 冠状动脉血管造影 (CA) 数据是在TAVI之前收集的.
- 多变量分析评估了CAD和PCI对2年死亡率的影响.
主要成果:
- 在379名患者中,14.5%的冠状动脉正常,31.6%的非阻塞性CAD,53.8%的阻塞性CAD.
- 穿皮冠状动脉干预 (PCI) 在29%的患者中进行.
- 患有复杂冠状动脉病变 (Syntax Score > 22) 的患者的两年生存率减少,但不是由于非阻塞性或阻塞性CAD,残留疾病或TAVI前PCI的存在.
结论:
- 阻塞性CAD的总体存在和管理没有显著影响TAVI后2年死亡率.
- 在出现复杂冠状动脉解剖的患者中,生存率显著下降.
- 这些发现表明,专注于复杂的冠状动脉病变可能比在TAVI候选人中所有CAD的常规再血管化更为关键.
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