Early- and mid-term outcomes of transcatheter aortic valve implantation in patients with logistic EuroSCORE less than 20%: A comparative analysis between different risk strata
Early- and mid-term outcomes of transcatheter aortic valve implantation in patients with logistic EuroSCORE less than 20%: A comparative analysis between different risk strata
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DOI：
10.1002/ccd.23100
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发表时间：
2012-01-01
影响因子：
2.3
通讯作者：
Ussia, Gian Paolo
中科院分区：
文献类型：
--
作者：
Tamburino, Corrado;Barbanti, Marco;Ussia, Gian Paolo
背景资料：经导管主动脉瓣植入术（TAVI）是一种新兴的药物治疗替代方案，适用于严重主动脉瓣狭窄的有限人群。欧洲共识文件建议对不适合常规手术的禁止性风险患者进行TAVI（禁止性风险定义为使用Logistic EuroScore（LES）结合临床判断计算的预期死亡率≥ 20%）。迄今为止，关于TAVI在低风险患者中的结局数据尚不明确。我们试图评价LES = 20%的TAVI患者与LES <20%的患者的结局。方法：在2007年6月至2010年9月期间在我机构使用18-French Medtronic CoreValve（N = 153）和Sapien Edwards TM（N 5 12）进行TAVI的165例患者中，我们确定了LES <20%的患者，植入了假体（n = 84），并报告了与LES >= 20%的患者（n = 78）相比的临床结果。主要终点是30天和中期随访时根据临床特征对患者进行分层的总体死亡和主要不良脑血管和心脏事件（MACCE）的发生率。结果如下：在30天时，MACCE的发生率显著较高，（20.8% vs. 6.0%，比值比[OR] 4.08，95%置信区间[CI] 1.42-11.74，P = 0.009）和死亡LES >= 20%组与LES < 20%组相比，分别报告了（15.6% vs. 2.4%，OR 7.45 95% CI 1.61-34.48，P = 0.010）。12个月MACCE发生率为（27.1% vs. 11.4%，风险比[HR] 2.47 95% CI 0.93-6.63，P = 0. 001）。071)LES ≥ 20%和LES < 20%的患者死亡率分别为25.7%和6.8%（HR 4.21，95% CI 1.24-14.30，P = 0.021）。结论：本研究倾向于表明，TAVI后报告的当前死亡率可能受到目前接受该手术的人群的极高风险特征的显著影响，因此与手术系列的比较相当不可靠。(C)2011 Wiley Periodicals，Inc.
Background: Transcatheter Aortic Valve Implantation (TAVI) is an emerging alternative to medical therapy reserved to a limited population with severe aortic stenosis. The European consensus document recommended TAVI for prohibitive-risk patients not eligible for conventional surgery (prohibitive risk defined as expected mortality = 20% calculated with the Logistic EuroScore (LES) in association with clinical judgment). To date, there is lack of clarity on data about outcomes of TAVI in lower risk patients. We sought to evaluate the outcomes of patients undergoing TAVI with LES = 20% in comparison with patients with LES < 20%. Method: Of 165 patients who underwent TAVI using the 18-French Medtronic CoreValve (N = 153) and the Sapien Edwards TM (N 5 12) at our Institution between June 2007 and September 2010, we identified those with LES < 20%, with prosthesis implantation (n = 84), and reported on their clinical outcome compared with patients with LES >= 20% (n = 78). The primary endpoint was the incidence of overall death and major adverse cerebrovascular and cardiac events (MACCE) at 30-day and midterm follow-up stratifying patients by clinical characteristics. Results: At 30-day, a significant higher incidence of MACCE (20.8% vs. 6.0%, odds ratio [OR] 4.08 95% confidence interval [CI] 1.42-11.74, P = 0.009) and death (15.6% vs. 2.4%, OR 7.45 95% CI 1.61-34.48, P = 0.010) was reported in the LES >= 20% group as compared with the LES < 20% group, respectively. The 12-month MACCE rates was (27.1% vs. 11.4%, hazard ratio [HR] 2.47 95% CI 0.93-6.63, P = 0. 071) for LES >= 20% and LES < 20% patients, respectively (mortality rates was 25.7% vs. 6.8% HR 4.21 95% CI 1.24-14.30, P = 0.021). Conclusion: This study tends to suggest that current mortality reported after TAVI could be significantly affected by the very-high risk profile of the population which currently undergoes this procedure, making comparison with surgical series rather unreliable. (C) 2011 Wiley Periodicals, Inc.