Circ: Cardiovasc Inte:经股动脉经导管主动脉瓣植入患者并发卒中的预测因子、发病率和预后

2019-03-29 xiangting MedSci原创

在这项大规模的全球患者水平分析中,经股动脉TAVI后卒中的发病率为2.4%。

卒中仍是经导管主动脉瓣植入术(TAVI)最严重的并发症之一。这项研究目的是确定TAVI后卒中的发病率、时间、时间趋势和预测因子,并评估卒中患者的预后。

CENTER-Collaboration是一项国际合作性研究,由3个全国性登记和7个当地登记或通过系统评价选出的前瞻性临床试验组成。因此,共有10982名在2007年至2018年间接受经股动脉TAVI的患者被纳入当前的患者水平汇总分析。TAVI后的第1个月,共有261名患者(2.4%)出现卒中。TAVI和卒中之间的中位时间为1天(四分位间距,0-6天)。早期TAVI手术(2007-2012)的卒中率与近年TAVI相当(2013-2018; 均为2.4%; P=1.0)。30天卒中的独立预测因子是脑血管事件病史(优势比,2.2;95%CI,1.4-3.6; P=0.0012)和肾小球滤过率<30mL/min/1.73m2(优势比,1.7;95%CI,1.0-2.8; P=0.05)。TAVI后30天内发生卒中与30天死亡率升高6倍相关(优势比,6.0; 95%CI,4.4-8.1;P<0.001)。此外,卒中患者在30天随访时更多地被记录有新发房颤(16%vs 3%; P<0.001)和主要或危及生命的出血(12%vs 7%; P=0.002)。

在这项大规模的全球患者水平分析中,经股动脉TAVI后卒中的发病率为2.4%。既往有脑血管事件和肾小球滤过率低可以独立预测TAVI后卒中的发生。TAVI后发生卒中与30天死亡率升高6倍相关;此外,卒中患者新发房颤的发病率高5倍。

原始出处:

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createdName=d830382, createdTime=Sun Oct 06 00:23:00 CST 2019, time=2019-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935940, encodeId=ed071935940a8, content=<a href='/topic/show?id=6d06e826033' target=_blank style='color:#2F92EE;'>#经导管主动脉瓣植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78260, encryptionId=6d06e826033, topicName=经导管主动脉瓣植入)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue May 28 15:23:00 CST 2019, time=2019-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758098, encodeId=8d631e5809883, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, 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=Sat Apr 27 10:23:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2010612, encodeId=daec201061232, 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=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81763, encryptionId=8abf81e6327, topicName=股动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Sun Sep 01 07:23:00 CST 2019, time=2019-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1938932, encodeId=acee193893247, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, 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=Sun Jan 12 08:23:00 CST 2020, time=2020-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310719, encodeId=d68f1310e19b8, content=<a href='/topic/show?id=25dc1002255e' target=_blank style='color:#2F92EE;'>#预测因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100225, encryptionId=25dc1002255e, topicName=预测因子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6105386, createdName=宋威, createdTime=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332630, encodeId=5b241332630ab, 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=20, 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=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415490, encodeId=99cb1415490cc, 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=24, 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=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510212, encodeId=9c9115102129d, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=)]
    2019-04-27 丁鹏鹏
  5. [GetPortalCommentsPageByObjectIdResponse(id=1823540, encodeId=b299182354015, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Fri May 24 17:23:00 CST 2019, time=2019-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691199, encodeId=02ab169119919, 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=32, 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=Sun Oct 06 00:23:00 CST 2019, time=2019-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935940, encodeId=ed071935940a8, content=<a href='/topic/show?id=6d06e826033' target=_blank style='color:#2F92EE;'>#经导管主动脉瓣植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78260, encryptionId=6d06e826033, topicName=经导管主动脉瓣植入)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue May 28 15:23:00 CST 2019, time=2019-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758098, encodeId=8d631e5809883, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, 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=Sat Apr 27 10:23:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2010612, encodeId=daec201061232, 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=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81763, encryptionId=8abf81e6327, topicName=股动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Sun Sep 01 07:23:00 CST 2019, time=2019-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1938932, encodeId=acee193893247, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, 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=Sun Jan 12 08:23:00 CST 2020, time=2020-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310719, encodeId=d68f1310e19b8, content=<a href='/topic/show?id=25dc1002255e' target=_blank style='color:#2F92EE;'>#预测因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100225, encryptionId=25dc1002255e, topicName=预测因子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6105386, createdName=宋威, createdTime=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332630, encodeId=5b241332630ab, 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=20, 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=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415490, encodeId=99cb1415490cc, 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=24, 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=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510212, encodeId=9c9115102129d, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1823540, encodeId=b299182354015, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Fri May 24 17:23:00 CST 2019, time=2019-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691199, encodeId=02ab169119919, 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=32, 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, 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encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Sat Apr 27 10:23:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2010612, encodeId=daec201061232, 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=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81763, encryptionId=8abf81e6327, topicName=股动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Sun Sep 01 07:23:00 CST 2019, time=2019-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1938932, encodeId=acee193893247, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, 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=Sun Jan 12 08:23:00 CST 2020, time=2020-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310719, encodeId=d68f1310e19b8, content=<a href='/topic/show?id=25dc1002255e' target=_blank style='color:#2F92EE;'>#预测因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100225, encryptionId=25dc1002255e, topicName=预测因子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6105386, createdName=宋威, createdTime=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332630, encodeId=5b241332630ab, 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=20, 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=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415490, encodeId=99cb1415490cc, 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=24, 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=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510212, encodeId=9c9115102129d, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Mar 31 04:23:00 CST 2019, time=2019-03-31, status=1, ipAttribution=)]
    2020-01-12 quxin068
  7. [GetPortalCommentsPageByObjectIdResponse(id=1823540, encodeId=b299182354015, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Fri May 24 17:23:00 CST 2019, time=2019-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691199, encodeId=02ab169119919, 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=32, 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, 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    2019-03-31 lsj631

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在急性脑出血患者中,DWI 小片高信号被认为与较高风险的复发性卒中(缺血和出血)、认知损害和死亡有关,并且逐渐发展成为慢性病灶,引起局部微结构损伤。然而,关于ICH 患者合并 DWI 高信号的研究主要来自于小型队列研究,大部分是脑淀粉样血管病的患者,尚不清楚这种 DWI 病灶是否为某一特定亚型ICH的特殊表现。

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复杂缺血性心肌病患者PCI术后消化道出血,并伴发房颤、脑栓塞,依据缺血/出血风险评估量表动态调整抗栓方案。应用吲哚布芬+OAC方案短期应用安全过渡后单用吲哚布芬抗栓治疗。兼顾抗血小板、抗凝治疗适应症,患者随访至今未发生缺血/出血并发症。

Ann Neurol:同型半胱氨酸和小血管卒中

这些发现表明,降低同型半胱氨酸的治疗在预防卒中的作用将局限于SVS亚型。MTHFR和MUT基因或附近的遗传变异是否通过除同型半胱氨酸水平和下游效应之外的途径影响SVS风险需要进一步研究。