A Stundl, L Preuss, A Prinzing, J C Voran, H Seoudy, I Mesanovic, V Obermeier, G Lutter, M Potratz, G Buglio, A Pohlmeyer, R Thalmann, P Hoppmann, C Bradaric, H Ruge, M Erlebach, R Lange, K L Laugwitz, T Pühler, T Rudolph, S Bleiziffer, M Krane, D Frank, C Kupatt
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Escpecially for intermediate-risk patients eligible for both interventional and surgical treatment, long-term benefit of either approach remains unclear.</p><p><strong>Objectives: </strong>To compare long-term outcomes of TAVI + PCI versus SAVR + CABG in intermediate-risk AS-CAD patients (logistic EuroSCORE 10-20%, EuroSCORE II 4-9%).</p><p><strong>Methods: </strong>This retrospective multicentre study included 366 patients treated between 2012 and 2020: 211 underwent TAVI + PCI and 155 received SAVR + CABG. The primary endpoint was all-cause mortality up to three years; secondary outcomes followed VARC-3 criteria.</p><p><strong>Results: </strong>Mortality rates were similar at 30 days (4.8% vs. 8.4%, p = 0.16), six months (12.4% each), one year (18.1% vs. 15.7%) and two years (24.9% vs. 20.1%). At three years, mortality was higher after TAVI + PCI (37.1% vs. 25.5%, p = 0.02), though CAD complexity was greater in the SAVR + CABG group (SYNTAX Score 22.2 vs. 15.9, p < 0.001). TAVI + PCI patients were older (81.1 vs. 78.5 years, p < 0.001), but surgical risk was comparable (EuroSCORE II 6.4% vs. 6.2%). Surgical patients experienced more complications, including delirium, stroke, acute kidney injury, major bleedings and transfusion needs. After propensity score matching (154 patients per group), 3-year mortality no longer differed significantly (33.8% vs. 25.9%, p = 0.14).</p><p><strong>Conclusion: </strong>Both TAVI + PCI and SAVR + CABG yield comparable long-term outcomes in intermediate-risk AS-CAD patients. 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引用次数: 0
摘要
背景：在严重主动脉狭窄（AS）的老年患者中，合并冠状动脉疾病（CAD）是常见的。特别是对于适合介入和手术治疗的中危患者，两种方法的长期获益尚不清楚。目的：比较TAVI + PCI与SAVR + CABG治疗中危AS-CAD患者的长期预后（logistic EuroSCORE 10-20%, EuroSCORE II 4-9%）。方法：这项回顾性多中心研究纳入了2012年至2020年期间接受治疗的366例患者：211例接受TAVI + PCI， 155例接受SAVR + CABG。主要终点是3年内的全因死亡率；次要结局符合VARC-3标准。结果：死亡率在30天（4.8%对8.4%,p = 0.16）、6个月（12.4%）、1年（18.1%对15.7%）和2年（24.9%对20.1%）时相似。三年后，TAVI + PCI术后死亡率更高（37.1% vs. 25.5%, p = 0.02），尽管SAVR + CABG组的CAD复杂性更高（句法评分22.2 vs. 15.9, p）。结论：TAVI + PCI和SAVR + CABG在中度风险AS-CAD患者中产生相当的长期结果。虽然早期并发症在手术中更为常见，但长期生存率有提高的趋势。
TAVI plus PCI versus SAVR plus CABG: Long-term outcome of a multicentre-registry.
Background: In elderly patients with severe aortic stenosis (AS), concomitant coronary artery disease (CAD) is common. Escpecially for intermediate-risk patients eligible for both interventional and surgical treatment, long-term benefit of either approach remains unclear.
Objectives: To compare long-term outcomes of TAVI + PCI versus SAVR + CABG in intermediate-risk AS-CAD patients (logistic EuroSCORE 10-20%, EuroSCORE II 4-9%).
Methods: This retrospective multicentre study included 366 patients treated between 2012 and 2020: 211 underwent TAVI + PCI and 155 received SAVR + CABG. The primary endpoint was all-cause mortality up to three years; secondary outcomes followed VARC-3 criteria.
Results: Mortality rates were similar at 30 days (4.8% vs. 8.4%, p = 0.16), six months (12.4% each), one year (18.1% vs. 15.7%) and two years (24.9% vs. 20.1%). At three years, mortality was higher after TAVI + PCI (37.1% vs. 25.5%, p = 0.02), though CAD complexity was greater in the SAVR + CABG group (SYNTAX Score 22.2 vs. 15.9, p < 0.001). TAVI + PCI patients were older (81.1 vs. 78.5 years, p < 0.001), but surgical risk was comparable (EuroSCORE II 6.4% vs. 6.2%). Surgical patients experienced more complications, including delirium, stroke, acute kidney injury, major bleedings and transfusion needs. After propensity score matching (154 patients per group), 3-year mortality no longer differed significantly (33.8% vs. 25.9%, p = 0.14).
Conclusion: Both TAVI + PCI and SAVR + CABG yield comparable long-term outcomes in intermediate-risk AS-CAD patients. Although early complications were more common with surgery, there was a trend towards improved long-term survival.
期刊介绍：
Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery.
As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.
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