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JACC:极简式经股动脉TAVR患者次日出院的预测因素及临床结局

2018-01-21 国际循环编辑部 国际循环

有关经导管主动脉瓣置换术(TVAR)后次日出院(NDD)预测因素及安全性的信息很少。JACC发表的一项最新研究评估TVAR后NDD的预测因素及安全性。

有关经导管主动脉瓣置换术(TVAR)后次日出院(NDD)预测因素及安全性的信息很少。JACC发表的一项最新研究评估TVAR后NDD的预测因素及安全性。

研究对2014年7月2016年7月行择期球囊扩张TAVR治疗的663例连续患者进行分析,探讨行极简式经股动脉TAVR患者NDD的预测因素,除外出现并发症的患者后采用Cox回归模型于校正美国胸外科学会(STS)提出的死亡率预测风险后比较NDD患者和住院时间较长患者的30天及1年结局。研究主要终点是1年死亡率和再住院的复合终点。

结果发现,行极简式经股动脉TAVR的患者平均年龄为(80.7±8.8)岁,平均STS预测死亡率风险为(6.6%±3.7)%;TAVR后NDD及非NDD者分别为150例和210例。NDD预测因素包括男性、不存在心房颤动、血肌酐水平及年龄,对应OR值分别为2.02(95%CI:1.28~3.18)、1.62(95%CI:1.02~2.57)、0.71(95%CI:0.55~0.92)和0.95(95%CI:0.93~0.98)。与研究预期一样,出现并发症的患者84%无法实现NDD。除外出现并发症患者后的分析显示,与非NDD患者相比,NDD患者的30天复合终点事件风险无差异(HR=0.62,95%CI:0.20~1.91),但1年复合终点发生风险明显降低(HR=0.47,95%CI:0.27~0.81)。进一步分析显示,NDD与非NDD患者1年复合终点的差异与NDD组患者非心血管相关再住院风险较低有关。

综上可见,男性、不存在心房颤动、血肌酐水平较低、年龄较小均是采用极简式经股动脉途径TAVR患者NDD的预测因素。对于无并发症患者,与住院时间较长者相比,NDD患者的安全性似乎更好,30天临床结局相似,但1年临床结局更优。

原始出处
Norihiko Kamioka, John Wells, Patricia Keegan, et al. Predictors and Clinical Outcomes of Next-Day Discharge After Minimalist TransfemoralTranscatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions. Jan 2018.

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    2018-07-01 hbwxf
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