跨导管大动脉替换无症状严重大动脉狭窄症
Philippe Généreux1, Allan Schwartz1, J Bradley Oldemeyer1
1From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.).
与常规监测相比,早期透气管大动脉置换 (TAVR) 显著降低了严重大动脉狭窄的患者死亡,中风或住院的风险. 这种早期干预策略为无症状患者提供了更好的结果.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 目前的指导方针建议对无症状的严重大动脉狭窄与保存的喷射分数进行监测.
- 关于早期跨导管大动脉置换 (TAVR) 与监测的随机试验数据缺乏.
研究的目的:
- 为了比较早期TAVR与无症状严重大动脉狭窄症患者的临床监测的疗效.
主要方法:
- 这是一项随机试验,涉及75个中心的901名患者.
- 患者被分为1:1进行早期的腿部输血TAVR或临床监测.
- 主要终点是死亡,中风或无计划的心血管住院的复合结果.
主要成果:
- 早期TAVR显著降低了主要终点 (26.8%对45.3%;危险率,0.50;P<0.001).
- 死亡率相似 (8.4% vs 9.2%),但TAVR显示中风和心血管住院率较低.
- 大多数监测患者 (87.0%) 最终接受了主动脉置换.
结论:
- 早期TAVR优于对无症状严重大动脉狭窄症的临床监测.
- 这一策略减少了死亡,中风或心血管住院的复合终点.
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