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JACC:女性经导管主动脉瓣置换术后的1年临床结局

2018-01-03 xiangting MedSci原创

既往血运重建和EuroSCORE I是VARC-2疗效终点的独立预测因子,而EuroSCORE I,基线房颤和既往PCI治疗是1年死亡或中风的独立预测因子。

这项研究旨在探讨在全部为女性的TAVR人群中,当代经导管主动脉瓣置换术(TAVR)的安全性和性能,并进一步研究女性的性别特征对复合1年临床结局的潜在影响。

接受TAVR的患者中≥50%为女性。有数据显示TAVR与外科主动脉瓣置换术相比,治疗症状明显的主动脉瓣狭窄具有非劣效性。但迄今还没有专门检测性别差异的研究。

WIN-TAVI(女性国际经导管主动脉瓣植入)登记是一项跨国前瞻性观察性的登记,针对2013年1月至2015年12月在欧洲18个地点和美国1个地点因明显主动脉瓣狭窄接受TAVR治疗的女性。初级瓣膜学术研究协会(VARC)-2疗效终点是死亡率、中风、心肌梗塞、瓣膜相关症状住院或心脏衰竭或瓣膜相关功能障碍超过30天的复合。次要终点包括复合性1年死亡或中风。1年结局的预测因子使用Cox回归方法确定。

共纳入1019名中到高危女性,平均年龄82.5±6.3岁,平均欧洲心脏手术风险评估系统(EuroSCORE)I为17.8±11.7%,平均胸外科医师协会评分为8.3±7.4%。90.6%TAVR经股动脉入路进行,新一代的器械被用于42.1%。主要的VARC-2疗效复合终点30天发生在111例(10.9%)患者,1年发生在167例(16.5%)患者。1年死亡或中风发生率为13.9%(141例)。127例患者(12.5%)死亡,22例(2.2%)患者卒中。先前的冠脉血运重建(危险比[HR]:1.72; 95%可信区间[CI]:1.17-2.52; p = 0.006)和EuroSCORE I(HR:1.02; 95%CI:1.00-1.04; p = 0.027)是VARC-2疗效终点的独立预测因子。同样的,EuroSCORE I(HR:1.02; 95%CI:1.00-1.04; p = 0.013),基线房颤(HR:1.58; 95%CI:1.07-2.33; p = 0.022)和之前PCI治疗(HR:1.50; 95%CI:1.03-2.19; P = 0.035)是1年死亡或卒中的独立预测因子。经调整后,妊娠史或任何性别特异性因素与1年TAVR结局之间没有显著关联。

这是首个全部为女性的当代TAVR登记研究,入选中到高危女性的1年VARC-2复合疗效终点为16.5%,1年死亡和中风的发生率较低。既往血运重建和EuroSCORE I是VARC-2疗效终点的独立预测因子,而EuroSCORE I,基线房颤和既往PCI治疗是1年死亡或中风的独立预测因子。

原始出处:
Alaide Chieffo, et al. 1-Year Clinical Outcomes in Women After Transcatheter Aortic Valve Replacement. JACC:Cardiovascular Interventions. January 2018. 

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    2018-10-23 hbwxf
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    2018-08-13 yxch48
  4. 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createdName=hbwxf, createdTime=Tue Oct 23 04:48:00 CST 2018, time=2018-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742461, encodeId=af1b1e4246123, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Aug 13 04:48:00 CST 2018, time=2018-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325658, encodeId=ea3e132565823, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, 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Jan 05 02:48:00 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576593, encodeId=037715e659300, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Fri Jan 05 02:48:00 CST 2018, time=2018-01-05, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1843138, encodeId=6ebd1843138aa, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Tue Jan 30 03:48:00 CST 2018, time=2018-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853894, encodeId=b7ee185389439, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, 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Jan 05 02:48:00 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576593, encodeId=037715e659300, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Fri Jan 05 02:48:00 CST 2018, time=2018-01-05, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1843138, encodeId=6ebd1843138aa, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Tue Jan 30 03:48:00 CST 2018, time=2018-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853894, encodeId=b7ee185389439, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, 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Jan 05 02:48:00 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576593, encodeId=037715e659300, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Fri Jan 05 02:48:00 CST 2018, time=2018-01-05, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1843138, encodeId=6ebd1843138aa, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Tue Jan 30 03:48:00 CST 2018, time=2018-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853894, encodeId=b7ee185389439, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, 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  8. 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    2018-01-05 lsj631
  9. 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