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首页> 外文期刊>The American Journal of Cardiology >Predictors of Long-term Cardiovascular Versus Non-cardiovascular Mortality and Repeat Intervention in Patients Having Transcatheter Aortic Valve Implantation
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Predictors of Long-term Cardiovascular Versus Non-cardiovascular Mortality and Repeat Intervention in Patients Having Transcatheter Aortic Valve Implantation

机译：长期心血管与非心血管死亡率的预测因子，重复干预患者具有经截面主动脉瓣植入的患者

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摘要

There is a paucity of literature characterizing the risk of long-term mortality and reintervention after transcatheter aortic valve implantation (TAVI). Addressing this gap has become increasingly relevant with the inclusion of intermediate and low surgical risk patients and the need for data to inform their long-term management. We sought to investigate the long-term trends and predictors of cardiovascular versus noncardiovascular mortality as well as reintervention in post-TAVI patients. Our cohort consisted of 5,406 patients who underwent TAVI in Ontario, Canada from 2011 to 2018. We used KaplanMeier analysis to estimate 7-year all-cause mortality and a Cox proportional hazard model to identify demographic, co-morbid, and procedural predictors. Similarly, cumulative incidence functions were used to estimate cardiovascular versus noncardiovascular mortality at 5 years, with predictors identified through Fine-Gray models. The KaplanMeier estimate for 7-year all-cause mortality in our cohort was 67%; this was driven by a number of co-morbidities including congestive heart failure and liver disease. We found that cardiovascular death was more likely for approximately the first 2 years post-TAVI whereas noncardiovascular death was more likely from this point to the end of the study. We identified a number of factors that uniquely modified the risk of either cardiovascular or noncardiovascular mortality. Only 1.6% of patients who underwent repeat intervention. The distinct factors associated with cardiovascular versus noncardiovascular death suggest different approaches to short-term and long-term surveillance of patients post-TAVI by both the heart team and primary care providers. (C) 2020 Elsevier Inc. All rights reserved.
机译：关于经导管主动脉瓣植入术（TAVI）后长期死亡率和再干预风险的文献很少。解决这一差距已变得越来越重要，因为纳入了中、低手术风险患者，并且需要数据为他们的长期管理提供信息。我们试图研究TAVI后患者心血管与非心血管死亡率以及再干预的长期趋势和预测因素。我们的队列包括2011年至2018年在加拿大安大略省接受TAVI治疗的5406名患者。我们使用Kaplan meier分析来估计7年全因死亡率，并使用Cox比例风险模型来确定人口统计学、共病和程序预测因素。同样，累积发病率函数用于估计5年时心血管与非心血管死亡率，预测因子通过精细灰色模型确定。我们队列中7年全因死亡率的Kaplan meier估计值为67%；这是由许多共同疾病引起的，包括充血性心力衰竭和肝病。我们发现，在TAVI术后的前两年，心血管死亡的可能性更大，而从这一点到研究结束，非心血管死亡的可能性更大。我们确定了一些独特的因素，可以改变心血管或非心血管死亡率的风险。只有1.6%的患者接受了重复干预。与心血管性和非心血管性死亡相关的不同因素表明，心脏团队和初级保健提供者对TAVI后患者进行短期和长期监测的方法不同。（C） 2020爱思唯尔公司版权所有。

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