在低风险患者中进行透气管与外科动脉置换:随机对照试验的更新元分析
Rohin K Reddy1, James P Howard2, Michael J Mack3
1National Heart and Lung Institute, Imperial College London, London, United Kingdom; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Journal of the American College of Cardiology
|March 5, 2025
概括
在风险较低的患者中,透气管大动脉置换 (TAVR) 与手术大动脉置换 (SAVR) 相比,改善了生存率,减少了死亡或致残性中风. 在这两种手术中,中风的发生率相似.
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
- 心脏外科手术 心脏外科手术
背景情况:
- 对于患有严重大动脉狭窄症的低风险患者,进行过导管大动脉置换 (TAVR) 或手术大动脉置换 (SAVR) 的患者,长期结果至关重要.
- 最近的随机试验提供了比较TAVR和SAVR的新数据,需要更新分析.
研究的目的:
- 进行一次更新的系统审查和随机证据的元分析,比较较低风险患者的TAVR和SAVR.
- 分析长期临床结果,包括存活率,中风和残疾性中风,使用汇总的个人参与者数据 (IPD).
主要方法:
- 六项随机试验的系统综述和元分析,涉及5341名低风险患者.
- 使用重建的时间到事件IPD与Cox比例危险脆弱回归和受限制的平均生存时间模型进行了聚合生存分析.
- 主要终点:全因死亡. 二级终点:中风和死亡或残疾性中风的复合.
主要成果:
- 在5年后,与SAVR相比,TAVR与所有原因死亡风险降低20% (HR:0.80) 和死亡或致残性中风风险降低19% (HR:0.81) 相联系.
- 在TAVR和SAVR之间没有观察到中风率的显著差异 (HR:0.97).
- 在包括的试验中,加权平均随访时间为35.7个月.
结论:
- 在较低风险的患者中,TAVR与SAVR相比,死亡和死亡或致残性中风风险降低,中风率相当.
- 调查结果表明,TAVR对于精选的低风险患者来说是一个有利的选择,但需要长期跟踪.
- 进一步的随机试验和延长的随访对年轻患者来说尤其重要,以充分阐明长期的比较疗效.
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