心房颤动患者经导管主动脉瓣植入术后1年随访结果

One-year follow-up results of atrial fibrillation patients who undergoing transcatheter aortic valve implantation

目的探讨经导管主动脉瓣植入(TAVI)术前合并心房颤动(房颤)是否会对患者的预后产生影响。方法本研究为单中心回顾性研究。入选2016年5月至2020年11月于北部战区总医院住院并成功接受TAVI治疗且顺利出院的重度主动脉瓣狭窄患者115例。根据入选患者是否合并房颤将其分为房颤组(21例)及非房颤组(94例)。随访纳入患者的术后抗栓治疗情况及终点事件的发生情况,终点事件为12个月的净不良心脑血管事件(NACCE),包括心原性死亡、因心力衰竭再入院、非致死性心肌梗死、缺血性卒中及严重出血[出血学术研究联合会(BARC)定义的3~5型出血]。采用单因素logistic回归分析NACCE事件的相关因素。结果本研究共纳入115例成功接受TAVI并顺利出院的重度主动脉瓣狭窄患者,年龄(73.8±6.9)岁,男性63例,其中21例(18.2%)在TAVI术前诊断为房颤。在术后抗栓治疗方面,非房颤组患者中48.9%(46/94)接受了单药抗血小板治疗,47.9%(45/94)接受了双联抗血小板治疗。房颤组患者中47.6%(10/21)使用抗凝药,33.3%(7/21)接受了双联抗血小板治疗。房颤组患者中服用非维生素K拮抗剂口服抗凝药(NOAC)的比例高于非房颤组[38.1%(8/21)比2.1%(2/94),P<0.001]。两组患者均完成了术后12个月的随访。房颤组患者在TAVI术后12个月的NACCE发生率为14.3%(3/21),在数值上高于非房颤组[6.4%(6/94)],但差异无统计学意义(P=0.441)。房颤组患者的严重出血发生率高于非房颤组[9.5%(2/21)比0,P=0.032]。单因素logistic回归分析结果显示,高血压与NACCE发生风险相关(OR=8.308,P=0.050),而房颤与NACCE发生风险无关(P=0.235)。结论房颤患者在TAVI术后严重出血发生率高于非房颤患者,NACCE发生率有增加的趋势。

Objective To investigate whether atrial fibrillation(AF)before transcatheter aortic valve implantation(TAVI)will affect the prognosis of patients post TAVI.Methods This is a single center retrospective study.A total of 115 patients with severe aortic stenosis(AS)who were admitted to General Hospital of Northern Theater Command from May 2016 to November 2020 and successfully received TAVI treatment were included.According to absence or accompaniment of AF pre-TAVI,they were divided into AF group(21 cases)and non-AF group(94 cases).The patients were followed up for postoperative antithrombotic treatment and the occurrence of the net adverse clinical and cerebrovascular events(NACCE)at 12 months post TAVI,including cardiogenic death,readmission to hospital for heart failure,nonfatal myocardial infarction,ischemic stroke and severe bleeding(BARC levels 3-5).Univariate logistic regression was used to analyze the related factors of NACCE.Results Among the 115 selected patients,age was(73.8±6.9)years,there were 63 males.And 21 cases(18.2%)were diagnosed as AFbefore TAVI.In terms of postoperative antithrombotic therapy,48.9%(46/94)of the patients in the non-AF group received monotherapy and 47.9%(45/94)received dual antiplatelet therapy.In the AF group,47.6%(10/21)received anticoagulants and 33.3%(7/21)received dual antiplatelet therapy.The proportion of patients in the AF group taking non-vitamin K antagonist oral anticoagulants(NOAC)was higher than that in the non-AF group(38.1%(8/21)vs.2.1%(2/94),P<0.001).Patients in both groups were followed up to 12 months after TAVI.During the 12 months follow-up,the incidence of NACCE after TAVI was 14.3%(3/21)in the AF group,which was numerically higher than that in the non-AF group(6.4%(6/94)),but the difference was not statistically significant(P=0.441).The incidence of severe bleeding was significantly higher in the AF group than in the non-AF group(9.5%(2/21)vs.0,P=0.032).Univariate logistic regression analysis showed that hypertension was associated with the risk of NACCE(OR=8.308,P=0.050),while AF was not associated with the risk of NACCE(P=0.235).Conclusion The incidence of severe bleeding after TAVI is higher in patients with AF than in patients without AF prior TAVI,and there is a trend of increased risk of NACCE post TAVI in AF patients.