Circ:Cardiovasc Inte:经股动脉经导管主动脉瓣置换术血管和出血并发症的发生率、时间趋势以及相关结局

2020-01-16 xiangting MedSci原创

在美国接受经导管主动脉瓣置换术的患者中,血管并发症和院内出血事件很常见,但其发生率随时间有所下降,并且各地医院的并发症发生率差异很大。血管和出血并发症均与短期和长期临床结局(包括全因死亡率)较差相关。

经导管主动脉瓣置换术临床试验中普遍存在血管和出血并发症。人们对当代美国临床实践中并发症的发生率或这些并发症的相关临床结局知之甚少。

研究评估了2011111日至2016630日胸外科医师协会/美国心脏病学会经导管瓣膜治疗登记中接受经导管主动脉瓣置换的患者。主要结局是院内血管并发症和出血事件。次要结局包括1年时的全因死亡率、卒中和再入院。计算发生率随时间变化趋势的P值,并使用多因素logistic回归确定血管/出血并发症与院内临床结局的关联。

共分析了在445家医院接受经导管主动脉瓣置换的34893名患者。其中,9.3%的患者(n = 3257)经历了血管并发症,而7.6%(n = 2651)发生了院内出血事件。血管并发症和出血事件的发生率均随时间下降(P趋势检验值<0.0001);但是,不同医院间的发生率差异很大(调整后的中位发生率为11.4%;IQR 8.9-14.5)。血管并发症与30天死亡(校正后HR2.23 [95CI1.80–2.77])、1年死亡(校正HR1.17 [95CI1.05-1.30])和再入院独立相关(校正HR1.14 [ 95CI1.07–1.22])。出血事件还与30天死亡(校正HR3.71 [95CI2.94–4.69])、1年死亡(校正HR1.39 [95CI1.23–1.56])和再入院相关(校正HR 1.19 [95CI1.11–1.27])。

在美国接受经导管主动脉瓣置换术的患者中,血管并发症和院内出血事件很常见,但其发生率随时间有所下降,并且各地医院的并发症发生率差异很大。血管和出血并发症均与短期和长期临床结局(包括全因死亡率)较差相关。为了减小这些有害并发症的发生率,有必要进一步创新以减小鞘管尺寸并优化抗血栓治疗。

原始出处:

Matthew W. Sherwood. Incidence, Temporal Trends, and Associated Outcomes of Vascular and Bleeding Complications in Patients Undergoing Transfemoral Transcatheter Aortic Valve Replacement. Circ: Cardiovascular Interventions. 15 January 2020.

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    2020-09-08 quxin068
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    2020-02-19 yxch48
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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415603, encodeId=dcdf141560356, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Jan 18 03:18:00 CST 2020, time=2020-01-18, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1939015, encodeId=9f9e193901511, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Tue Sep 08 12:18:00 CST 2020, time=2020-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2010619, encodeId=0492201061933, content=<a href='/topic/show?id=8abf81e6327' target=_blank style='color:#2F92EE;'>#股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81763, encryptionId=8abf81e6327, topicName=股动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415603, encodeId=dcdf141560356, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Jan 18 03:18:00 CST 2020, time=2020-01-18, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1939015, encodeId=9f9e193901511, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Tue Sep 08 12:18:00 CST 2020, time=2020-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2010619, encodeId=0492201061933, content=<a href='/topic/show?id=8abf81e6327' target=_blank style='color:#2F92EE;'>#股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81763, encryptionId=8abf81e6327, topicName=股动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, 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encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Wed Jul 29 03:18:00 CST 2020, time=2020-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691205, encodeId=51d316912055e, content=<a href='/topic/show?id=320ee8456be' target=_blank style='color:#2F92EE;'>#经股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78456, encryptionId=320ee8456be, topicName=经股动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=efdf29169795, createdName=d830382, createdTime=Mon Jun 01 07:18:00 CST 2020, time=2020-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758193, encodeId=bd301e581933f, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Mon Jul 06 11:18:00 CST 2020, time=2020-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951610, encodeId=ef3a19516109f, content=<a href='/topic/show?id=53a5595e1dc' target=_blank style='color:#2F92EE;'>#时间趋势#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59571, encryptionId=53a5595e1dc, topicName=时间趋势)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, createdName=sjzlzc007, createdTime=Sat Sep 12 01:18:00 CST 2020, time=2020-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332701, encodeId=b5c31332e01b0, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sat Jan 18 03:18:00 CST 2020, time=2020-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367199, encodeId=118e136e199a4, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Sat Jan 18 03:18:00 CST 2020, time=2020-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415603, encodeId=dcdf141560356, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Jan 18 03:18:00 CST 2020, time=2020-01-18, status=1, ipAttribution=)]
    2020-07-06 丁鹏鹏
  7. 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