大动脉置换方法的医院变化在65岁以下患者的大动脉狭窄症的选择
Sundos Alabbadi1, Aminah Sallam2, Derrick Tam2
1Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States.
概括
在65岁以下的患者中,跨导管大动脉置换 (TAVR) 的使用因医院而异. 高水平的TAVR使用与增加的死亡率,中风和感染风险有关,这表明仔细选择患者至关重要.
科学领域:
- 心血管外科心血管外科
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在65岁以下的患者中,建议对严重的大动脉狭窄进行外科大动脉置换 (SAVR).
- 在这个年轻人群中,透管大动脉置换 (TAVR) 的使用正在增加.
- 在TAVR采用中存在医院变异,需要对结果进行评估.
研究的目的:
- 评估TAVR在65岁以下患者中使用的医院变异对临床结果的影响.
- 评估医院TAVR偏好如何影响死亡率,中风,传染性内心炎和永久心脏起器植入.
主要方法:
- 利用美国3个州的数据 (2013-2021) 来计算每个医院的观察到预期的TAVR比率.
- 医院根据其比例被分为三级 (低,中,高TAVR使用) 类.
- 逻辑回归和考克斯比例危险模型评估了30天和6年死亡率,中风,IE和PPI的风险.
主要成果:
- 具有高TAVR比率的医院有较少伴随疾病的患者.
- 在高和中等TAVR使用的医院30天后观察到永久心脏起器植入 (PPI) 的更高率 (17%对7.6%对5.6%).
- 在高TAVR使用医院的患者面临6年死亡率增加的风险 (8.1%对5.3%),中风 (2.2%对1.1%) 和传染性内心炎 (IE) (2.9%对0.3%).
结论:
- 对于65岁以下患者的TAVR使用的医院变化与不同的临床结果有关.
- 较高的TAVR采用率与死亡率,中风和IE风险的增加相关.
- 在年轻人 (65岁以下) 接受TAVR的患者选择需要仔细考虑临床形状和预期寿命.
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