慢性四肢威胁性缺血症与跨导管大动脉置换后的较高死亡率和四肢再血管化有关
Khanjan B Shah1, Mohammed Elzeneini1, Dan Neal2
1Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
The American journal of cardiology
|September 25, 2023
概括
患有慢性肢体威胁性缺血症 (CLTI) 接受过导管大动脉置换 (TAVR) 的患者面临更高的死亡率和并发症风险. 然而,整体不良事件发生率仍然很低,这表明TAVR是选择CLTI患者的可行选择.
科学领域:
- 心血管医学 心血管医学
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
背景情况:
- 周围动脉疾病 (PAD) 在症状主动脉狭窄的患者中很普遍.
- 慢性肢体威胁性缺血症 (CLTI) 是最严重的PAD形式,显著增加了肢体损失和死亡风险.
- 超导管大动脉置换 (TAVR) 是对大动脉狭窄的常见治疗方法,但其在CLTI患者的结果需要进一步调查.
研究的目的:
- 确定患有和没有CLTI的患者的TAVR手术的患者特征和临床结果.
- 评估CLTI与住院死亡率,重大并发症和TAVR后的再血管化率之间的关联.
主要方法:
- 从2015年10月到2018年12月使用国家住院样本数据库对TAVR住院病人的回顾性分析.
- 使用国际疾病分类第十版代码识别患有CLTI的患者.
- 在TAVR患者与没有CLTI之间比较住院死亡率,重大并发症,开放式再血管化和内血管再血管化.
主要成果:
- 总共有31,335例TAVR住院病例被分析,其中7,048例 (22.5%) 涉及患有CLTI的患者.
- 显著地,CLTI与更高的住院死亡率 (OR 1.4) 和重大并发症 (OR 1.2) 有关.
- 患有CLTI的患者在TAVR后的开放性 (OR 5.1) 和内血管性 (OR 4.0) 肢体再血管化的比率明显更高.
结论:
- TAVR患者的CLTI与增加的住院死亡率,重大并发症和更长的住院时间有关.
- 尽管存在这些关联,但这一群体中不良事件的总体发病率仍然很低.
- 优化多学科护理和共享决策对于管理患有CLTI的TAVR患者至关重要.
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