Impact of Severity and Extent of Iliofemoral Atherosclerosis on Clinical Outcomes in Patients Undergoing TAVR

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2024-10-28 DOI:10.1016/j.jcin.2024.07.009

Masaaki Nakase MD , Daijiro Tomii MD , Daryoush Samim MD , Christoph Gräni MD , Fabien Praz MD , Jonas Lanz MD, MSc , Stefan Stortecky MD, MPH , David Reineke MD , Stephan Windecker MD , Thomas Pilgrim MD, MSc

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引用次数: 0

Abstract

Background

Vascular complications remain a major concern in transfemoral transcatheter aortic valve replacement (TAVR). The Hostile score has been proposed to stratify risk in TAVR patients with peripheral artery disease.

Objectives

The authors aimed to assess the validity of the Hostile score in predicting iliofemoral vascular complications after TAVR.

Methods

In a prospective TAVR registry, we validated the Hostile score for the prediction of puncture and non–puncture site vascular complications. This scoring system integrates the extent (number of lesions, lesion length, and minimum lumen diameter) and complexity (tortuosity, calcification, and the presence of obstruction) of iliofemoral atherosclerosis.

Results

Of 2,023 patients who underwent transfemoral TAVR with contemporary devices between March 2014 and June 2022, 106 (5.2%) patients experienced puncture site vascular complications and 28 (1.4%) patients experienced non–puncture site vascular complications. The Hostile score was higher in patients with vascular complications than those without complications (1.00 [Q1-Q3: 0-5.00] vs 1.00 [Q1-Q3: 0-4.00]; P < .001). A higher body mass index (OR: 1.23; 95% CI: 1.04-1.50) and the use of Prostar (OR: 6.03; 95% CI: 2.23-16.30) or MANTA (OR: 6.18; 95% CI: 2.67-14.27) compared with ProGlide were independent predictors of puncture site vascular complications, whereas a higher Hostile score (OR: 1.91; 95% CI: 1.55-2.35) and female sex (OR: 2.69; 95% CI: 1.12-6.42) were independent predictors of non–puncture site vascular complications. The area under the receiver-operating characteristic curves for the prediction of puncture site and non–puncture site vascular complications were 0.554 and 0.829, respectively.

Conclusions

The Hostile score proved useful in predicting non–puncture site vascular complications after TAVR. (SwissTAVI Registry; NCT01368250).

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髂股动脉粥样硬化的严重程度和范围对接受 TAVR 患者临床结果的影响

背景：血管并发症仍是经口经导管主动脉瓣置换术（TAVR）的主要问题。Hostile评分已被提出用于对患有外周动脉疾病的TAVR患者进行风险分层：作者旨在评估 Hostile 评分在预测 TAVR 术后髂股血管并发症方面的有效性：在一项前瞻性 TAVR 登记中，我们验证了 Hostile 评分预测穿刺和非穿刺部位血管并发症的有效性。该评分系统综合了髂股动脉粥样硬化的程度（病变数量、病变长度和最小管腔直径）和复杂性（迂曲、钙化和是否存在阻塞）：2014年3月至2022年6月期间，2023名患者使用当代设备接受了经股动脉TAVR，其中106名（5.2%）患者出现了穿刺部位血管并发症，28名（1.4%）患者出现了非穿刺部位血管并发症。血管并发症患者的 "敌对 "评分高于无并发症患者（1.00 [Q1-Q3: 0-5.00] vs 1.00 [Q1-Q3: 0-4.00]; P < .001）。与 ProGlide 相比，体重指数越高（OR：1.23；95% CI：1.04-1.50），使用 Prostar（OR：6.03；95% CI：2.23-16.30）或 MANTA（OR：6.18；95% CI：2.67-14.与 ProGlide 相比，Prostar（OR：6.03；95% CI：2.23-16.30）或 MANTA（OR：6.18；95% CI：2.67-14.27）是穿刺部位血管并发症的独立预测因素，而较高的 Hostile 评分（OR：1.91；95% CI：1.55-2.35）和女性性别（OR：2.69；95% CI：1.12-6.42）是非穿刺部位血管并发症的独立预测因素。预测穿刺部位和非穿刺部位血管并发症的接受者操作特征曲线下面积分别为 0.554 和 0.829：结论：Hostile评分有助于预测TAVR术后非穿刺部位血管并发症。(瑞士TAVI注册；NCT01368250）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.