慢性冠状动脉全闭塞对经导管主动脉瓣置换术患者心血管预后的影响:一项系统综述和荟萃分析

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE
Aman Goyal , Muhammad Daoud Tariq , Areeba Ahsan , Sonia Hurjkaliani , Ajeet Singh , Hafiz Muhammad Hamza , Hritvik Jain , Hareesha Rishab Bharadwaj , Mohamed Daoud , Abu Baker Sheikh
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引用次数: 0

摘要

背景:经导管主动脉瓣置换术(TAVR)显著促进了严重主动脉瓣狭窄(AS)的治疗,特别是对经常伴有冠状动脉疾病(CAD)的老年患者。慢性全闭塞(CTO)是一种严重的CAD形式,可能会对TAVR患者的预后产生负面影响,尽管数据有限。本荟萃分析旨在评估CTO对TAVR结果的影响。方法:在多个电子数据库中进行全面的文献检索,以确定比较CTO患者和非CTO患者TAVR结果的研究。采用随机效应模型计算95%置信区间(ci)的合并风险比(RR)。主要终点是全因死亡率,还评估了几个次要终点。结果:本荟萃分析纳入了6项研究,共涉及331,159例TAVR患者。CTO与院内死亡风险显著增加相关(RR: 1.24;95% ci: 1.01, 1.52;p = 0.04),急性心肌梗死(RR: 1.67;95% ci: 1.48, 1.89;结论:CTO对TAVR患者具有显著的风险,特别是对住院死亡率和急性心肌梗死。建议对这些患者采用多学科方法,并考虑在TAVR之前进行血运重建术。需要进一步的研究来评估先前CTO-PCI的潜在益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis

Background

Transcatheter aortic valve replacement (TAVR) has significantly advanced the treatment of severe aortic stenosis (AS), particularly in elderly patients who often have coexisting coronary artery disease (CAD). Chronic total occlusion (CTO), a severe form of CAD, may negatively impact outcomes in TAVR patients, though data are limited. This meta-analysis aims to evaluate the impact of CTO on TAVR outcomes.

Methods

A comprehensive literature search was conducted across multiple electronic databases to identify studies comparing TAVR outcomes in patients with and without CTO. Pooled risk ratios (RR) with 95 % confidence intervals (CIs) were calculated using a random-effects model. The primary outcome was all-cause mortality, with several secondary endpoints also assessed.

Results

Six studies involving a total of 331,159 TAVR patients were included in this meta-analysis. CTO was associated with a significantly increased risk of in-hospital mortality (RR: 1.24; 95 % CI: 1.01, 1.52; p = 0.04), acute myocardial infarction (RR: 1.67; 95 % CI: 1.48, 1.89; p < 0.00001), acute kidney injury (RR: 1.46; 95 % CI: 1.37, 1.56; p < 0.00001), and vascular complications (RR: 1.47; 95 % CI: 1.28, 1.69; p < 0.00001). No significant differences were observed in all-cause mortality (RR: 1.21; 95 % CI: 0.76, 1.93; p = 0.42), stroke (RR: 1.09; 95 % CI: 0.91, 1.30; p = 0.37), or bleeding events (RR: 1.19; 95 % CI: 1.00, 1.41; p = 0.06).

Conclusion

CTO poses a significant risk in TAVR patients, particularly for in-hospital mortality and acute myocardial infarction. A multidisciplinary approach is recommended for these patients, with consideration given to revascularization before TAVR. Further studies are needed to evaluate the potential benefits of prior CTO-PCI.
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