在跨导管大动脉置换之前的高风险入院和随后的结果
Jarl Emanuel Strange1, Nina Nouhravesh2, Morten Schou2
1Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
American heart journal
|November 16, 2023
概括
经历过心力衰竭,心肌梗塞或昏迷的患者在过导管大动脉置换 (TAVR) 之前的预后较差. 这些人需要有针对性的资源管理和有针对性的干预措施来改善TAVR后的结果.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏门疾病 心脏门疾病
背景情况:
- 严重的,有症状的大动脉狭窄可以导致心力衰竭,心肌梗塞或昏迷.
- 关于这些先前事件对跨导管大动脉置换 (TAVR) 后结果的影响的数据有限.
研究的目的:
- 调查先前事件 (心力衰竭,心肌梗塞,昏迷) 与TAVR后的结果之间的关联.
主要方法:
- 一项全国性的队列研究包括丹麦患者从2014年至2021年接受TAVR.
- 在鉴定TAVR前180天内发生的先前事件.
- 使用调整后的考克斯回归分析,在患有和没有先前事件的患者之间比较了全因死亡和心血管/全因住院的一年风险.
主要成果:
- 在5851名TAVR患者中,13.0%的患者有先前的事件,最常见的是心力衰竭住院治疗.
- 患有先前事件的患者有更高的1年死亡风险 (11.7% vs 8.0%,aHR 1.29) 和心血管再住院 (15.0% vs 8.2%,aHR 1.60).
- 在TAVR之前入院心力衰竭后,死亡率最高 (1年风险:13.5%).
结论:
- 在TAVR之前因心力衰竭,心肌梗塞或昏迷住院与更差的预后有关.
- 这些患者是高风险群体,需要有针对性的资源管理.
- 预防性干预和优化TAVR前后护理对于这种患者群体至关重要.
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