计算机断层扫描作为入侵性血管造影的门卫的可行性 在TAVR之前:一个务实的现实世界经验
Asa Phichaphop1,2, Paul Sorajja1,3, Maurice Enriquez-Sarano1
1Valve Science Center, Minneapolis Heart Institute Foundation, MN. (A.P., P.S., M.E.-S., A.O., M.A., E.W.-K., J.R.L., V.N.B., N.H.).
Circulation. Cardiovascular interventions
|May 21, 2025
概括
常规计算机断层扫描血管造影 (TAVR-CTA) 在跨导管大动脉置换 (TAVR) 之前有效地选冠状动脉疾病 (CAD). 这种方法安全地豁免了许多患者的侵入性冠状动脉血管学 (ICA),提高了效率.
科学领域:
- 心脏病学 心脏病学
- 放射学 放射学是一门学科.
- 干预心脏病学 干预心脏病学
背景情况:
- 前导管大动脉置换计算机断层扫描血管造影 (TAVR-CTA) 与侵入性冠状动脉血管造影 (ICA) 相对应良好,用于排除阻塞性冠状动脉疾病 (CAD).
- 在TAVR之前,TAVR-CTA作为ICA的门卫的临床有效性和安全性仍然不清楚.
研究的目的:
- 为了确定是否常规的TAVR-CTA,没有前期治疗,可以安全地推迟或指导在接受TAVR前评估的患者中需要ICA.
- 评估TAVR-CTA在治疗冠状动脉疾病的临床实用性,在TAVR之前进行冠状动脉疾病查.
主要方法:
- 追溯研究包括2017年至2022年期间评估TAVR的1165名患者,分为TAVR-CTA或ICA组进行CAD查.
- 排除先前有冠状动脉旁路移植的患者.
- 主要结局是TAVR1年后的症状驱动的再血管化.
主要成果:
- 在TAVR-CTA (37%) 和ICA (41%) 组之间,CAD的患病率相似.
- 53%的患者在TAVR-CTA后因没有阻塞性CAD而免除了ICA.
- 对于阻塞性CAD,TAVR-CTA显示了89%的灵敏度和91%的负预测值.
- 一年后症状驱动的复血管化,急性冠状动脉综合征和非计划性ICA的发生率较低,在各组之间相似.
结论:
- 将TAVR-CTA集成到TAVR前的工作流程中,可以使高达53%的患者免于ICA,同时保持安全.
- 这一策略可能会改善 TAVR 计划中的患者获取,体验,价值和吞吐量.
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