心房颤动对经导管主动脉瓣置入术患者预后的影响

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-03-01 DOI:10.1016/j.hroo.2024.12.016

Jakob J. Reichl MD , Thorald Stolte , Jasper Boeddinghaus MD, Max Wagener MD, Gregor Leibundgut MD, Patrick Badertscher MD, Christian Sticherling MD, Michael Kühne MD, Christoph Kaiser MD, Felix Mahfoud MD, Thomas Nestelberger MD

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引用次数: 0

摘要

房颤（AF）是最常见的心律失常，也是心脏不良结局（包括心力衰竭和中风）的重要危险因素。此外，房颤与经导管主动脉瓣植入术（TAVI）后较差的预后有关。关于房颤对TAVI后预后影响的实际数据仍然有限。目的评价心房纤颤对TAVI术后围手术期及短期预后的影响。方法在三级中心接受TAVI的患者连续纳入前瞻性登记。使用12导联心电图评估基线时的心律。主要终点是30天的全因死亡率。次要结局包括1年全因死亡率，30天和1年卒中，手术成功，定义为术中死亡、手术再干预、主动脉瓣再干预、主要通路并发症和术中出血直到出院。结果1655例TAVI患者中，428例（25.6%）患者既往存在房颤，77例（4.6%）患者在TAVI住院期间被诊断为新发房颤。房颤与30天的高死亡率无关(3.7% vs 2.0%；P = 0.054，校正风险比[aHR]， 1.8[95%可信区间（CI）， 0.9-3.4])，但1年后(13.8% vs 8.4%；P = .001；aHR, 1.6 [95%CI, 1.2-2.2])。房颤患者30天卒中发生率更高(5.9% vs 2.7%；P = .003；aHR, 2.1 [95%CI, 1.2-3.5])和1年(7.1% vs 3.8%；P = 0.005；aHR, 1.8 [95%CI, 1.2 ~ 2.9])。出院时，452例（89.5%）房颤患者接受口服抗凝治疗。调整抗凝治疗后，30天卒中风险差异(5.7% vs 2.3%；P = 0.058)和1年(6.8% vs 4.2%；P = .165)不再显著。房颤患者出现更多严重或危及生命的出血并发症(14.2% vs 10.6%；P = .043)。有房颤和无房颤患者的手术成功率没有差异(78.8% vs 78.3%；P = .886)。结论房颤与TAVI术后1年死亡率增高、30天和1年卒中和大出血发生率增高有关。

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Prognostic impact of atrial fibrillation in patients undergoing transcatheter aortic valve implantation

Background

Atrial fibrillation (AF) is the most common arrhythmia and an important risk factor for adverse cardiac outcomes, including heart failure and stroke. Moreover, AF has been linked to worse outcomes after transcatheter aortic valve implantation (TAVI). Real-world data on the impact of AF on outcomes after TAVI remain limited.

Objective

To assess the impact of AF on periprocedural and short-term outcomes after TAVI.

Methods

Patients undergoing TAVI at a tertiary center were consecutively included in a prospective registry. Cardiac rhythm at baseline was assessed using 12-lead ECGs. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included all-cause mortality at 1 year, stroke at 30 days and 1 year, and procedural success, defined as freedom from periprocedural mortality, surgical re-interventions, re-interventions of the aortic valve, major access site complications, and periprocedural bleedings until discharge.

Results

Among 1655 patients undergoing TAVI, 428 patients (25.6%) had preexisting AF, and 77 patients (4.6%) were diagnosed with new-onset AF during hospitalization for TAVI. AF was not associated with higher mortality at 30 days (3.7% vs 2.0%; P = .054, adjusted hazard ratio [aHR], 1.8 [95% confidence interval (CI), 0.9–3.4]), but at 1 year (13.8% vs 8.4%; P = .001; aHR, 1.6 [95%CI, 1.2–2.2]). The stroke rate was higher in patients with AF at 30 days (5.9% vs 2.7%; P = .003; aHR, 2.1 [95%CI, 1.2–3.5]) and at 1 year (7.1% vs 3.8%; P = .005; aHR, 1.8 [95%CI, 1.2–2.9]). At discharge, 452 patients (89.5%) with AF received oral anticoagulation. After adjusting for anticoagulant therapy, the difference in stroke risk at 30 days (5.7% vs 2.3%; P = .058) and 1 year (6.8% vs 4.2%; P = .165) was no longer significant. Patients with AF experienced more major or life-threatening bleeding complications (14.2% vs 10.6%; P = .043). There were no differences in procedural success between patients with and those without AF (78.8% vs 78.3%; P = .886).