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量化与高梯度严重大动脉狭窄症晚期治疗指示相关的生存损失

David De Azevedo¹, Marin Boute¹, Christophe Tribouilloy^2,3

¹Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, Belgium.

|June 28, 2024

概括

在严重的大动脉狭窄患者的大动脉置换之前,等待症状或减少喷射率显著降低了长期生存率. 建议在这些触发因素出现之前进行早期干预,以获得高梯度严重大动脉狭窄症的更好的结果.

科学领域:

心脏病学心脏病学
心脏外科手术心脏外科手术
临床结果临床结果

背景情况:

国际指导方针建议对高梯度严重大动脉狭窄症 (HGSAS) 患者进行大动脉置换 (AVR),这些患者有症状或左心室喷射率 (LVEF) <50%.
等待这些指南定义的触发因素对术后存活率的影响尚不清楚.

研究的目的:

调查基于指南的I类触发剂对HGSAS患者AVR后长期生存的影响.

主要方法:

分析了一组2030名接受AVR的HGSAS患者.
患者根据症状的存在和LVEF (<50%或>50%) 进行了分类.
用于匹配的反向概率权衡,并限制了平均存活时间的分析寿命损失.

主要成果:

与没有触发因素 (67.1%) 相比,症状 (56.4%) 或LVEF <50% (53.1%) 的患者的十年生存率明显较低.
症状或LVEF<50%增加了调整后的死亡风险 (HR分别为1.45和1.47).
患有LVEF<60%的患者的AVR导致11.4个月的存活率在10年内丧失,与患有LVEF>60%的无症状患者相比.

结论:

在HGSAS中基于指南的AVR触发器显著影响长期存活率,这表明在症状出现或LVEF下降之前早期AVR的好处.
这些发现质疑LVEF值的必要性,因为运行LVEF<60%与生存处罚有关.

关键词:

大动脉狭窄症 (大动脉狭窄)这些指导方针是指导方针.国际注册表国际注册表国际注册表左心室喷射分数的部分.幸存率幸存率生存率症状症状症状症状症状

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