Changes in Demographics, Initial Treatment Strategies, and Clinical Outcomes of Severe Aortic Stenosis in the Pre- and Post-TAVR Era in Japan.
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Takeji Yasuaki, Taniguchi Tomohiko, Morimoto Takeshi, Shirai Shinichi, Kitai Takeshi, Tabata Hiroyuki, Ohno Nobuhisa, Murai Ryosuke, Osakada Kohei, Murata Koichiro, Nakai Masanao, Tsuneyoshi Hiroshi, Tada Tomohisa, Amano Masashi, Watanabe Shin, Shiomi Hiroki, Watanabe Hirotoshi, Yoshikawa Yusuke, Nishikawa Ryusuke, Obayashi Yuki, Yamamoto Ko, Toyofuku Mamoru, Tatsushima Shojiro, Kanamori Norio, Miyake Makoto, Nakayama Hiroyuki, Nagao Kazuya, Izuhara Masayasu, Nakatsuma Kenji, Inoko Moriaki, Fujita Takanari, Masahiro Kimura, Ishii Mitsuru, Usami Shunsuke, Nakazeki Fumiko, Inuzuka Yasutaka, Ando Kenji, Komiya Tatsuhiko, Ono Koh, Minatoya Kenji, Kimura Takeshi, CURRENT AS Registry-2 Investigators
Аннотация
METHODS: We analyzed 2 multicenter registries that consecutively enrolled patients with severe aortic stenosis before and after the introduction of transcatheter AVR in Japan (CURRENT AS [CURRENT AS, Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis] Registry-1: 2003-2011; Registry-2: 2018-2020). Data were derived from hospital electronic health records. The primary outcome was 1-year all-cause mortality. Secondary outcomes included hospitalization for heart failure, cardiovascular death, and noncardiovascular death. we Multivariable Cox proportional hazards models were adjusted for age, sex, body mass index, hypertension, current smoking, diabetes on insulin therapy, prior myocardial infarction, prior symptomatic stroke, atrial fibrillation or flutter, aortic or peripheral vascular disease, creatinine level, hemodialysis, anemia, liver cirrhosis (child B or C), malignancy currently under treatment, chronic lung disease (moderate or severe), coronary artery disease, peak aortic jet velocity, any combined moderate or severe valvular disease, and tricuspid regurgitation pressure gradient.
RESULTS: A total of 6645 patients (Registry-1: 3448 patients, and Registry-2: 3197 patients) were included. Patients in Registry-2 were older than those in Registry-1 (81.7 versus 77.8 years), and an initial AVR strategy was more frequently selected (49.9% versus 31.3%). The cumulative 1-year incidence and adjusted risk of 1-year all-cause mortality were lower in Registry-2 than in Registry-1 (10.2% versus 16.0%, P<0.001, hazard ratio, 0.55 [95% CI, 0.47-0.63]). In contrast, the incidence and adjusted risk of hospitalization for heart failure did not differ between Registry-2 and Registry-1 (8.5% versus 9.0%, P=0.66, hazard ratio, 0.88 [95% CI, 0.75-1.04]).
CONCLUSIONS: The overall 1-year mortality outcome of patients with severe aortic stenosis improved in the posttranscatheter AVR era compared with the pretranscatheter AVR era, with no noticeable improvement in hospitalization for heart failure.