早期的大动脉置换与无症状患者的临床监测与严重的大动脉狭窄症患者的临床监测
Yasuaki Takeji1, Tomohiko Taniguchi2, Takeshi Morimoto3
1Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
The American journal of cardiology
|June 9, 2025
概括
对于具有高梯度的无症状严重大动脉狭窄症 (AS),早期大动脉置换 (AVR) 在临床监测中没有显著的益处. 死亡,中风或心力衰竭住院的综合结果在三年内各组之间是相似的.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 临床试验 临床试验
背景情况:
- 在无症状严重的大动脉狭窄症 (AS) 中进行大动脉置换 (AVR) 的最佳时间是有争议的.
- 高梯度的严重AS需要仔细考虑干预与监测.
研究的目的:
- 为了比较早期AVR的临床结果与高梯度严重AS无症状患者的临床监测.
- 评估所有死因,中风或心力衰竭住院治疗的风险.
主要方法:
- 从CURRENT AS Registry-2中对412名患有高梯度严重AS的无症状患者进行了倾向性得分匹配分析.
- 在初始AVR策略和临床监测策略之间对3年复合结果的比较.
主要成果:
- 在初始AVR (26.4%) 和临床监测 (28.4%) 组 (p=0.46) 中,初始复合结果的3年累计发病率相似.
- 在监测组中,转换为AVR发生在6个月后的11.1%,1年后的32.9%和3年后的69.0%.
- 对于主要结果,危险比率 (0.85;95% CI:0.56-1.29) 没有显著差异.
结论:
- 在无症状的高梯度严重AS患者中,初始AVR策略与临床监测相比,没有降低死亡,中风或心力衰竭住院的风险.
- 这些发现表明,临床监测可能是选择高梯度严重AS无症状患者的合理方法.
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