在低风险的医疗保险受益者中,手术或透管大动脉置换
J Hunter Mehaffey1, Mohammad Kawsara2, Vikrant Jagadeesan2
1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
The Journal of thoracic and cardiovascular surgery
|April 30, 2024
概括
在75岁以下的低风险患者中,手术性大动脉置换 (SAVR) 显示出较高的初始风险,但比过导管大动脉置换 (TAVR) 更好的长期结果. 在三年内,SAVR改善了生存率,并降低了中风和再干预率.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 经导管大动脉置换 (TAVR) 越来越多地用于低风险患者,因为最近获得批准.
- 需要真实世界的数据来评估TAVR与外科主动脉置换 (SAVR) 在这个不断扩大的人群中的结果.
- 医疗保险受益者是评估这些干预措施的重要人口群体.
研究的目的:
- 为了比较SAVR和TAVR在低风险医疗保险受益人的实际结果.
- 评估术后和纵向结果,包括中风,死亡率和重新干预率.
主要方法:
- 美国医疗保险和医疗补助服务中心索赔数据库 (2018-2020) 的分析.
- 包括15,749名低风险患者 (8,144名SAVR,7,605名TAVR) 接受隔离性大动脉置换.
- 采用了两倍强大的风险调整和竞争风险时间到事件分析.
主要成果:
- 与SAVR相比,TAVR与较低的术后中风和医院死亡率有关.
- 然而,TAVR显示了较高的风险调整后期中风发病率,门再干预和全因死亡率.
- 这些纵向差异在统计学上是显著的.
结论:
- 在75岁以下的低风险医疗保险受益者中,SAVR与较高的初始发病率和死亡率有关.
- 与TAVR相比,SAVR在中风,门再干预和生存方面表现出优异的3年风险调整结果.
- 这些发现表明,SAVR可能在这个特定的患者群体中提供更好的长期结果.
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