Xiangming Hu, Zhenyan Zhao, Can Wang, Dejing Feng, Yang Chen, Guannan Niu, Zheng Zhou, Hongliang Zhang, Zhe Li, Yunqing Ye, Moyang Wang, Yongjian Wu
{"title":"经导管主动脉瓣置换术围手术期心肌损伤的预测因素及预后影响","authors":"Xiangming Hu, Zhenyan Zhao, Can Wang, Dejing Feng, Yang Chen, Guannan Niu, Zheng Zhou, Hongliang Zhang, Zhe Li, Yunqing Ye, Moyang Wang, Yongjian Wu","doi":"10.2147/CIA.S505174","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The impact of periprocedural myocardial injury (PPMI) according to VARC-3 criteria in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to investigate the incidence, risk factors, and prognosis of PPMI in patients with severe aortic who underwent TAVR in China.</p><p><strong>Materials and methods: </strong>Between September 2012 and November 2021, 516 patients with severe aortic stenosis who underwent TAVR at the Fuwai Hospital were consecutively enrolled. PPMI was defined according to the VARC-3 criteria as a 70-fold increase of upper reference limit in cardiac troponin I (cTnI) levels. We compared the baseline characteristics, perioperative conditions, and in-hospital and long-term endpoints between the PPMI and non-PPMI groups. Logistic regression analysis was used to determine the predictors of PPMI. Survival probabilities for outcomes between the PPMI and non-PPMI groups were estimated using the Kaplan-Meier method.</p><p><strong>Results: </strong>Of the enrolled patients (mean age: 75.5±7.2 years, 57.5% male), the incidence of PPMI was 20.5%. The median cTnI was 24.9 (interquartile range: 11.4-60.2) times the upper reference limit. After multivariable adjustment, female sex (odds ratio [OR]: 3.01, 95% confidence interval [CI]: 1.88-4.82, <i>P</i> < 0.001), anticoagulant use (OR: 0.27, 95% CI: 0.08-0.96, <i>P</i> = 0.043), balloon-expandable valve (OR: 0.27, 95% CI: 0.09-0.79, <i>P</i> = 0.017), and secondary valve implantation (OR: 2.66, 95% CI: 1.40-5.03, <i>P</i> = 0.003) were significantly associated with PPMI. Patients with PPMI had short- and long-term outcomes similar to those without PPMI.</p><p><strong>Conclusion: </strong>Female sex and secondary valve implantation are predictors of an increased risk of PPMI, whereas baseline anticoagulant use and the use of balloon-expandable valves are protective factors. The presence of PPMI does not seem to indicate poor short- or long-term prognosis in patients undergoing TAVR.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"125-135"},"PeriodicalIF":3.5000,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829743/pdf/","citationCount":"0","resultStr":"{\"title\":\"Predictors and Prognostic Effects of Perioperative Myocardial Injury After Transcatheter Aortic Valve Replacement According to VARC-3 Criteria.\",\"authors\":\"Xiangming Hu, Zhenyan Zhao, Can Wang, Dejing Feng, Yang Chen, Guannan Niu, Zheng Zhou, Hongliang Zhang, Zhe Li, Yunqing Ye, Moyang Wang, Yongjian Wu\",\"doi\":\"10.2147/CIA.S505174\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The impact of periprocedural myocardial injury (PPMI) according to VARC-3 criteria in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to investigate the incidence, risk factors, and prognosis of PPMI in patients with severe aortic who underwent TAVR in China.</p><p><strong>Materials and methods: </strong>Between September 2012 and November 2021, 516 patients with severe aortic stenosis who underwent TAVR at the Fuwai Hospital were consecutively enrolled. PPMI was defined according to the VARC-3 criteria as a 70-fold increase of upper reference limit in cardiac troponin I (cTnI) levels. We compared the baseline characteristics, perioperative conditions, and in-hospital and long-term endpoints between the PPMI and non-PPMI groups. Logistic regression analysis was used to determine the predictors of PPMI. Survival probabilities for outcomes between the PPMI and non-PPMI groups were estimated using the Kaplan-Meier method.</p><p><strong>Results: </strong>Of the enrolled patients (mean age: 75.5±7.2 years, 57.5% male), the incidence of PPMI was 20.5%. The median cTnI was 24.9 (interquartile range: 11.4-60.2) times the upper reference limit. After multivariable adjustment, female sex (odds ratio [OR]: 3.01, 95% confidence interval [CI]: 1.88-4.82, <i>P</i> < 0.001), anticoagulant use (OR: 0.27, 95% CI: 0.08-0.96, <i>P</i> = 0.043), balloon-expandable valve (OR: 0.27, 95% CI: 0.09-0.79, <i>P</i> = 0.017), and secondary valve implantation (OR: 2.66, 95% CI: 1.40-5.03, <i>P</i> = 0.003) were significantly associated with PPMI. Patients with PPMI had short- and long-term outcomes similar to those without PPMI.</p><p><strong>Conclusion: </strong>Female sex and secondary valve implantation are predictors of an increased risk of PPMI, whereas baseline anticoagulant use and the use of balloon-expandable valves are protective factors. 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引用次数: 0
摘要
目的：经导管主动脉瓣置换术（TAVR）患者术中围术期心肌损伤（PPMI）是否符合VARC-3标准尚不清楚。本研究旨在探讨中国重度主动脉瓣置换术患者PPMI的发生率、危险因素及预后。材料与方法：2012年9月至2021年11月，连续入组阜外医院516例重度主动脉瓣狭窄患者行TAVR。根据VARC-3标准，PPMI被定义为心肌肌钙蛋白I （cTnI）水平参考上限增加70倍。我们比较了PPMI组和非PPMI组的基线特征、围手术期条件、住院和长期终点。采用Logistic回归分析确定PPMI的预测因素。使用Kaplan-Meier方法估计PPMI组和非PPMI组之间结果的生存概率。结果：入组患者平均年龄75.5±7.2岁，男性57.5%，PPMI发生率为20.5%。中位cTnI为参考上限的24.9倍（四分位数间距：11.4-60.2）。多变量调整后，女性（优势比[OR]: 3.01, 95%可信区间[CI]: 1.88-4.82, P < 0.001）、抗凝剂使用（OR: 0.27, 95% CI: 0.08-0.96, P = 0.043）、球型可膨胀瓣膜（OR: 0.27, 95% CI: 0.09-0.79, P = 0.017）和二次瓣膜植入（OR: 2.66, 95% CI: 1.40-5.03, P = 0.003）与PPMI显著相关。PPMI患者的短期和长期预后与非PPMI患者相似。结论：女性和二次瓣膜植入是PPMI风险增加的预测因素，而基线抗凝剂使用和球囊可膨胀瓣膜的使用是保护因素。PPMI的存在似乎并不表明TAVR患者短期或长期预后不良。
Predictors and Prognostic Effects of Perioperative Myocardial Injury After Transcatheter Aortic Valve Replacement According to VARC-3 Criteria.
Purpose: The impact of periprocedural myocardial injury (PPMI) according to VARC-3 criteria in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to investigate the incidence, risk factors, and prognosis of PPMI in patients with severe aortic who underwent TAVR in China.
Materials and methods: Between September 2012 and November 2021, 516 patients with severe aortic stenosis who underwent TAVR at the Fuwai Hospital were consecutively enrolled. PPMI was defined according to the VARC-3 criteria as a 70-fold increase of upper reference limit in cardiac troponin I (cTnI) levels. We compared the baseline characteristics, perioperative conditions, and in-hospital and long-term endpoints between the PPMI and non-PPMI groups. Logistic regression analysis was used to determine the predictors of PPMI. Survival probabilities for outcomes between the PPMI and non-PPMI groups were estimated using the Kaplan-Meier method.
Results: Of the enrolled patients (mean age: 75.5±7.2 years, 57.5% male), the incidence of PPMI was 20.5%. The median cTnI was 24.9 (interquartile range: 11.4-60.2) times the upper reference limit. After multivariable adjustment, female sex (odds ratio [OR]: 3.01, 95% confidence interval [CI]: 1.88-4.82, P < 0.001), anticoagulant use (OR: 0.27, 95% CI: 0.08-0.96, P = 0.043), balloon-expandable valve (OR: 0.27, 95% CI: 0.09-0.79, P = 0.017), and secondary valve implantation (OR: 2.66, 95% CI: 1.40-5.03, P = 0.003) were significantly associated with PPMI. Patients with PPMI had short- and long-term outcomes similar to those without PPMI.
Conclusion: Female sex and secondary valve implantation are predictors of an increased risk of PPMI, whereas baseline anticoagulant use and the use of balloon-expandable valves are protective factors. The presence of PPMI does not seem to indicate poor short- or long-term prognosis in patients undergoing TAVR.
期刊介绍：
Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.
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