在美国接受大动脉置换的患者中并发症的趋势
James E Harvey1, Samir R Kapadia2, David J Cohen3
1WellSpan Health System York PA USA.
Journal of the American Heart Association
|August 27, 2024
概括
过导管大动脉置换 (TAVR) 和严重大动脉狭窄的外科大动脉置换 (SAVR) 在2012年至2019年期间的并发症率有所下降. 与SAVR相比,TAVR显示出更大的并发症减少.
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:
- 严重的大动脉狭窄症的治疗已经通过跨导管大动脉置换 (TAVR) 取得了进展.
- 对TAVR与外科动脉置换 (SAVR) 的并发症的国家趋势仍未评估.
- 了解并发症趋势对于优化患者的治疗结果至关重要.
研究的目的:
- 评估接受选择性隔离输膜TAVR或SAVR的患者主要并发症的时间趋势.
- 为了比较TAVR和SAVR之间的并发症风险随着时间的推移.
- 评估TAVR采用对严重大动脉狭窄症并发症率的影响.
主要方法:
- 使用医疗保险数据 (2012-2019) 的回顾性队列研究.
- 纳入65岁以上的受益人接受选择性隔离输血性TAVR或SAVR.
- 在30天内使用多变量逻辑回归分析主要并发症.
主要成果:
- 整体并发症率从2012年的49%降至2019年的22%.
- 对TAVR (22%的下降) 的并发症减少比SAVR (4%的下降) 更明显.
- 风险调整后的分析显示,TAVR与SAVR相比,并发症几率明显较低 (2012年为47%,2019年为78%),随着时间的推移,益处越来越大.
结论:
- 大动脉置换并发症风险在2012年至2019年期间显著下降.
- 超导管大动脉置换 (TAVR) 显示出比手术大动脉置换 (SAVR) 更大的绝对和相对减少并发症.
- 这些发现凸显了TAVR在治疗严重大动脉狭窄症方面的不断变化的安全性和益处.
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