心脏损伤分期预测大动脉置换后大动脉狭窄的结果:元分析
Omar M Abdelfattah1, Xander Jacquemyn2, Michel Pompeu Sá3
1Division of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA.
JACC. Advances
|June 28, 2024
概括
心脏损伤阶段预测大动脉狭窄症 (AS) 患者进行大动脉置换 (AVR) 的死亡率. 更高的阶段与全因死亡率的增加相关,有助于治疗时间和患者选择以改善预后.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 临床预后 临床预后
背景情况:
- 大动脉狭窄 (AS) 是一种重要的心血管疾病.
- 基于额外膜损伤的心脏损伤阶段已经被提议用于中度/重度AS的预后评估.
- 这种分期系统的预后价值需要在接受干预的AS患者群体中进行验证.
研究的目的:
- 评估AS患者心脏损伤阶段化和死亡率之间的关联,这些患者接受了主动脉置换 (AVR),无论是通过手术还是通过导管.
- 评估基线心脏损伤阶段化在AS严重程度和症状的全谱的预后影响.
主要方法:
- 使用从卡普兰-梅尔曲线重建的时间到事件数据进行了聚合的元分析.
- 数据来源于到2023年2月发表的16项符合条件的研究.
- 分析包括14499名患者,包括12282名具有症状严重的AS和2217名具有无症状中度/严重的AS.
主要成果:
- 在症状严重的AS患者中,随着心脏损伤阶段的升高,5年全因死亡率显著增加 (阶段0:24.0%至阶段4:57.3%).
- 死亡危险比率在每个阶段都大大增加,例如,与0.0阶段相比,第三阶段HR 2.92 (P < 0.001) 和第四阶段HR 3.51 (P < 0.001) 的死亡危险比率在第3阶段HR 2.92 (P < 0.001) 和第4阶段HR 3.51 (P < 0.001) 都大大增加.
- 在无症状的中度/重度AS患者中,八年全因死亡率也随着阶段的增加而上升 (阶段0:19.3%至阶段3-4:67.8%),具有显著的危险比率 (例如,阶段3-4HR3.90,P<0.001).
结论:
- 基线心脏损伤阶段是AS患者经历AVR的显著预后指标.
- 这种分期系统可以为治疗决策提供信息,包括AVR的时间和辅助疗法的需要.
- 使用心脏损伤分期可能有助于预防不可逆转的损伤,并改善AS患者的长期结果.
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