通过导管大动脉植入后感染性内心炎的风险不断变化
Sundos H Alabbadi1, Alexander Iribarne2, Josep Rodés-Cabau3,4
1Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY, 10029, United States.
概括
通过导管大动脉植入术 (TAVI) 后感染性内心炎的发生率在2019年后的医疗保险患者中下降,这与较少的非选择性手术有关. 然而,TAVI感染性内心炎的30天死亡率仍然是一个挑战.
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
- 公共卫生 公共卫生
背景情况:
- 过导管大动脉植入 (TAVI) 越来越多地用于患有严重大动脉狭窄的老年人.
- 传染性内心炎 (IE) 是TAVI后的一种罕见但严重的并发症.
- 关于TE发病率和TAVI后的结果的当代数据有限.
研究的目的:
- 分析医疗保险受益人的TAVI后IE1年发病率的趋势.
- 为了确定与IE发病率和TAVI后的结果相关的因素.
- 为了评估随着时间的推移,IE管理和死亡率的变化.
主要方法:
- 对从2013年到2022年接受TAVI的280,073名医疗保险受益者的分析.
- 加入点回归来评估IE发病率的趋势 (每年百分比变化).
- 调整了考克斯模型,以评估IE与患者特征和12个月后结果的关联.
主要成果:
- 在TAVI后的一年IE发病率从2013年的20.0/1000人/年下降到2021年的13.1/1000人/年,在2018年 (-12.1%APC) 之后显著下降.
- 这种下降与减少的非选举TAVI率相关.
- 虽然TAVI扩张率增加,但移植后30天死亡率下降;然而,TAVI-IE的整体30天风险调整后死亡率保持不变.
结论:
- 医疗保险患者的TAVI IE后发病率在2019年后下降,与较少的非选择性手术和TAVI扩展到较低风险患者相关.
- 塔维的爆发率很低,但最近有所增加.
- 对TAVI-IE持续不变的30天死亡率突出显示了TAVI.IE后管理老年患者的持续挑战.
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