经导管主动脉瓣置换术后需要心脏起搏器植入的患者的长期预后

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-05-12 DOI:10.1016/j.jcin.2025.03.028

Patrick Badertscher MD , Stefan Stortecky MD , Teodor Serban MD , Sven Knecht DCs, PhD , Dik Heg MD, PhD , David Tueller MD , Raban Jeger MD, EMBAr , Oliver Reuthebuch MD , Olivier Muller MD, PhD , Stefan Toggweiler MD , Peter Wenaweser MD , Christoph Huber MD , Marco Roffi MD , Enrico Ferrari MD , Tobias Reichlin MD , Thomas Nestelberger MD , Felix Mahfoud MD , Michael Kühne MD , Christian Sticherling MD , SwissTAVI Investigators

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引用次数: 0

摘要

背景：起搏器（PM）植入对经导管主动脉瓣置换术（TAVR）后预后的影响仍然存在争议，特别是当TAVR适应症扩展到低风险患者时。目的评价TAVR术后PM植入术患者的全因死亡率和心血管死亡率。方法在这项前瞻性、观察性、全国性的TAVR队列研究中，研究永久性PM植入患者的预后。2011年2月至2022年6月期间，瑞士19个中心招募了患者。结果入组的13360例患者（平均年龄82±7岁，女性47%，自扩张瓣膜48%，中位随访889天[Q1-Q3: 365- 1765天]）中，2028例（15%）患者在tavr术后30天内需要PM植入。需要tavr后PM植入的患者年龄较大（82±6岁对81±7岁），主要是男性（58%对50%），并且更常患有房颤（34%对29%）。在1年的随访中，这些患者的总死亡率更高(aHR: 1.15；95% ci: 1.05-1.26；P = 0.002)和心血管死亡率(aHR: 1.25；95% ci: 1.06-1.46；p = 0.006)。这些趋势在5年和10年的随访中持续存在。多变量调整后，1年随访时观察到心血管死亡率显著升高，LVEF下降≥10%，NYHA功能等级为III或IV级(aHR: 1.44,；95% ci: 1.35-1.54；P & lt;0.001)， TAVR术后需要PM植入的患者与不需要PM植入的患者相比，随访5年和10年的全因死亡率和心血管死亡率更高。结论：在这项全国性的大型登记中，TAVR术后30天内接受PM植入的患者在10年内的总体死亡率和心血管死亡率均显著升高。(SwissTAVI注册表;NCT01368250)

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Long-Term Outcomes of Patients Requiring Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Background

The impact of pacemaker (PM) implantation on outcomes following transcatheter aortic valve replacement (TAVR) remains controversial, especially as TAVR indications expand to low-risk patients.

Objectives

This study sought to evaluate the all-cause and cardiovascular mortality of patients undergoing PM implantation after TAVR.

Methods

In this prospective, observational, nationwide TAVR cohort study, the outcomes of patients undergoing permanent PM implantation were investigated. Patients were enrolled from 19 centers across Switzerland between February 2011 and June 2022.

Results

Among 13,360 patients enrolled (mean age 82 ± 7 years, 47% female, self-expanding valves 48%, median follow-up 889 days [Q1-Q3: 365-1,765 days]), 2,028 (15%) required PM implantation within 30 days post-TAVR. Patients requiring post-TAVR PM implantation were older (82 ± 6 years of age vs 81 ± 7 years of age), were predominantly male (58% vs 50%), and more often had atrial fibrillation (34% vs 29%). At 1-year follow-up, these patients had higher overall mortality (aHR: 1.15; 95% CI: 1.05-1.26; P = 0.002) and cardiovascular mortality (aHR: 1.25; 95% CI: 1.06-1.46; P = 0.006). These trends persisted at 5- and 10-year follow-up. After multivariable adjustments, significantly higher rates of cardiovascular mortality, LVEF decline ≥10%, and NYHA functional class III or IV at 1-year follow-up were observed (aHR: 1.44,; 95% CI: 1.35-1.54; P < 0.001), along with higher all-cause and cardiovascular mortality rates at 5- and 10-year follow-up in patients requiring PM implantation following TAVR compared with those not needing a PM.

Conclusions

In this large nationwide registry, patients receiving PM implantation within 30 days after TAVR had significantly higher rates of overall and cardiovascular mortality up to 10 years. (SwissTAVI Registry; NCT01368250)

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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.