Risk of Ischemic Stroke in Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Prior Stroke.
Risk of Ischemic Stroke in Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Prior Stroke.
复制标题
既往中风患者经导管主动脉瓣植入术与手术主动脉瓣置换术的缺血性中风风险。
DOI：
10.1016/j.amjcard.2021.06.049
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Aaqib H. Malik
中科院分区：
文献类型：
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作者：
T. Ando;Said Ashraf;A. Briasoulis;H. Takagi;C. Grines;Aaqib H. Malik
对于有缺血性卒中病史的患者，经导管主动脉瓣植入术（TAVI）或外科主动脉瓣置换术（SAVR）是否具有较低的缺血性卒中（IS）风险尚未得到充分研究。从2015年10月至2017年11月的全国再入院数据库中，50岁以上的TAVI和SAVR使用国际疾病分类第十版临床修改/手术编码系统代码进行识别。排除了经心尖TAVI和SAVR伴旁路、二尖瓣或三尖瓣手术。主要结局为院内IS。共识别出92，435例TAVI（13，292例既往卒中）和68，651例SAVR（5，365例既往卒中）。TAVI的院内IS显著低于SAVR（3.7% vs 8.0%，校正比值比0.65，95%置信区间0.47 - 0.89，p <0.01），而TAVI和SAVR之间相似（1.7%vs2.1%，95%可信区间0.78 ~ 1.19，p = 0.75）（P < 0.001）。在既往有或无卒中史的患者中，TAVI组的住院死亡率、急性肾损伤和出血均低于SAVR组（P交互作用均> 0.05）。对国家索赔数据库的分析表明，在既往卒中患者中，与SAVR相比，TAVI与院内IS风险较低相关。
It has not been well studied whether transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) have lower risk of ischemic stroke (IS) in those with prior history of IS. From the Nationwide Readmission Database from October 2015 to November 2017, TAVI and SAVR above age 50 were identified with theInternational Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding Systemcodes. Transapical TAVI and SAVR with concomitant bypass, mitral, or tricuspid surgery were excluded. The primary outcome was in-hospital IS. A total of 92,435 TAVI (13,292 with prior stroke) and 68,651 SAVR (5,365 with prior stroke) were identified. In-hospital IS was significantly lower in TAVI compared with SAVR (3.7% vs 8.0%, adjusted odds ratio 0.65, 95% confidence interval 0.47 to 0.89, p <0.01) with prior stroke whereas it was similar between TAVI and SAVR (1.7% vs 2.1%, adjusted odds ratio 0.97, 95% confidence interval 0.78 to 1.19, p = 0.75) in those without prior stroke (Pinteraction< 0.001). In-hospital mortality, acute kidney injury, and bleeding were lower in TAVI compared with SAVR in patients with and without prior stroke (Pinteraction> 0.05 for all). This analysis of a national claims database showed that TAVI was associated with a lower risk of in-hospital IS compared with SAVR among patients with prior stroke.