TAVI加PCI与SAVR加CABG:多中心注册表的长期结果
A Stundl1,2, L Preuss3,4, A Prinzing5
1Department of Internal Medicine I, Cardiology, Klinikum Rechts Der Isar, TUM School of Medicine & Health, Technische Universität München, Munich, Germany.
概括
对于患有严重大动脉狭窄和冠状动脉疾病的中等风险患者,透气管大动脉植入加上穿皮冠状动脉干预 (TAVI+PCI) 和外科大动脉置换加上冠状动脉旁路移植 (SAVR+CABG) 显示了类似的长期结果.
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:
- 患有严重大动脉狭窄症 (AS) 的老年患者往往同时患有冠状动脉疾病 (CAD).
- 接受TAVI+PCI与SAVR+CABG治疗的中等风险患者的长期结果仍然不清楚.
- 这项研究侧重于中等风险的AS-CAD患者 (后勤EuroSCORE 10-20%,EuroSCORE II 4-9%).
研究的目的:
- 为了比较TAVI+PCI与SAVR+CABG在中等风险AS-CAD患者的长期结果.
- 为了评估两种治疗策略之间的死亡率,并发症和整体存活率的差异.
主要方法:
- 追溯多中心研究,包括366名患者 (2012-2020年).
- 211名患者接受了TAVI+PCI,155人接受了SAVR+CABG.
- 主要终点:所有原因死亡率高达三年;次要结果遵循VARC-3标准.
主要成果:
- 在三年后,TAVI+PCI (37.1%) 的死亡率高于SAVR+CABG (25.5%),p=0.02.
- 然而,SAVR+CABG组的CAD复杂性更大 (SYNTAX评分为22.2比15.9).
- 在倾向分数匹配后,3年死亡率没有显著差异 (33.8%与25.9%,p=0.14),手术患者有更多的早期并发症.
结论:
- 在中等风险的AS-CAD患者中,TAVI+PCI和SAVR+CABG产生了可比的长期结果.
- 虽然手术导致了更多的早期并发症,但SAVR+CABG治疗的长期存活率有所改善.
- 在选择治疗时,应考虑个体患者的因素和程序风险.
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