TAVR后1年病因特异性死亡率的时间趋势：来自STS/ACC TVT登记的见解

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-04-28 DOI:10.1016/j.jcin.2024.12.016

Dhaval Kolte MD, PhD, MPH , Guillaume Marquis-Gravel MD, MSc , Amanda Stebbins MS , Andrew M. Vekstein MD , Sreekanth Vemulapalli MD , Sammy Elmariah MD, MPH

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引用次数: 0

摘要

背景：经导管主动脉瓣置换术（TAVR）后患者人口统计学和风险概况变化对病因特异性死亡率的影响尚不清楚。目的：本研究的目的是检查TAVR后的死亡原因（CoDs）、时间趋势和原因特异性死亡率的预测因素。方法：分析来自胸外科学会/美国心脏病学会TVT（经导管瓣膜治疗）登记处的数据，以确定2012年1月至2022年10月期间接受孤立性TAVR的患者，这些患者具有1年CoD的可用信息。主要结局是1年的死因特异性（心脏和非心脏）死亡率。精细和灰色亚分布风险模型用于解释特定原因死亡的竞争风险。结果：36,877例TAVR术后1年内死亡且有CoD信息的患者中，11,560例（31.3%）为心源性死亡，25,317例（68.7%）为非心源性死亡。从2012年到2017年，TAVR术后1年心脏和非心脏死亡的风险调整风险最初下降（调整后的HR每年分别为0.95 [95% CI: 0.92-0.97]和0.92 [95% CI: 0.90-0.93]），随后从2018年到2022年上升（调整后的HR每年分别为1.07 [95% CI: 1.05-1.09]和1.22 [95% CI: 1.20-1.24]）。年龄0 ~ 80岁、合并症、功能状态差、非选择性手术、非股骨通路和院内并发症被确定为TAVR术后心源性和非心源性死亡的独立预测因素。结论：非心脏原因占TAVR术后1年内死亡的三分之二。需要进一步的研究来检验近年来COVID-19大流行、TAVR位点数量的快速扩张，或其他患者和医院特征是否导致了TAVR术后心脏和非心脏死亡风险的增加。

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Temporal Trends in 1-Year Cause-Specific Mortality After TAVR

Background

The impact of changing patient demographics and risk profiles on cause-specific mortality after transcatheter aortic valve replacement (TAVR) remains unclear.

Objectives

The aim of this study was to examine causes of death (CoDs) and temporal trends and predictors of cause-specific mortality after TAVR.

Methods

Data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry were analyzed to identify patients who underwent isolated TAVR between January 2012 and October 2022 who had available information on 1-year CoD. The primary outcome was cause-specific (cardiac and noncardiac) mortality at 1 year. Fine and Gray subdistribution hazard models were used to account for the competing risk for cause-specific death.

Results

Of 36,877 patients who died within 1 year after TAVR and had available information on CoD, 11,560 (31.3%) had cardiac death and 25,317 (68.7%) had noncardiac death. There was an initial decline in the risk-adjusted hazards of 1-year cardiac and noncardiac death after TAVR from 2012 to 2017 (adjusted HR per year: 0.95 [95% CI: 0.92-0.97] and 0.92 [95% CI: 0.90-0.93], respectively), followed by an increase from 2018 to 2022 (adjusted HR per year: 1.07 [95% CI: 1.05-1.09] and 1.22 [95% CI: 1.20-1.24], respectively). Age >80 years, comorbidities, poor functional status, nonelective procedure, nonfemoral access, and in-hospital complications were identified as independent predictors of both cardiac and noncardiac death after TAVR.

Conclusions

Noncardiac causes account for two-thirds of deaths within 1 year after TAVR. Further studies are needed to examine whether the COVID-19 pandemic, the rapid expansion in the number of TAVR sites, or other patient and hospital characteristics contributed to the increased risk for cardiac and noncardiac death after TAVR in recent years.

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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.