Transcatheter aortic valve implantation versus conservative management for severe aortic stenosis in real clinical practice


Autoři: Yasuaki Takeji aff001;  Tomohiko Taniguchi aff002;  Takeshi Morimoto aff003;  Naritatsu Saito aff001;  Kenji Ando aff002;  Shinichi Shirai aff002;  Genichi Sakaguchi aff004;  Yoshio Arai aff004;  Yasushi Fuku aff005;  Yuichi Kawase aff005;  Tatsuhiko Komiya aff006;  Natsuhiko Ehara aff007;  Takeshi Kitai aff007;  Tadaaki Koyama aff008;  Shin Watanabe aff001;  Hirotoshi Watanabe aff001;  Hiroki Shiomi aff001;  Eri Minamino-Muta aff001;  Shintaro Matsuda aff001;  Hidenori Yaku aff001;  Yusuke Yoshikawa aff001;  Kazuhiro Yamazaki aff009;  Masahide Kawatou aff009;  Kazuhisa Sakamoto aff009;  Toshihiro Tamura aff010;  Makoto Miyake aff010;  Hisashi Sakaguchi aff011;  Koichiro Murata aff012;  Masanao Nakai aff013;  Norio Kanamori aff014;  Chisato Izumi aff015;  Hirokazu Mitsuoka aff016;  Masashi Kato aff017;  Yutaka Hirano aff018;  Tsukasa Inada aff019;  Kazuya Nagao aff019;  Hiroshi Mabuchi aff020;  Yasuyo Takeuchi aff021;  Keiichiro Yamane aff022;  Takashi Tamura aff023;  Mamoru Toyofuku aff023;  Mitsuru Ishii aff024;  Moriaki Inoko aff025;  Tomoyuki Ikeda aff026;  Katsuhisa Ishii aff027;  Kozo Hotta aff028;  Toshikazu Jinnai aff029;  Nobuya Higashitani aff029;  Yoshihiro Kato aff030;  Yasutaka Inuzuka aff031;  Yuko Morikami aff032;  Kenji Minatoya aff010;  Takeshi Kimura aff0010
Působiště autorů: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan aff001;  Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan aff002;  Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan aff003;  Division of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan aff004;  Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan aff005;  Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan aff006;  Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan aff007;  Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan aff008;  Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan aff009;  Department of Cardiology, Tenri Hospital, Tenri, Japan aff010;  Cardiovascular Surgery, Tenri Hospital, Tenri, Japan aff011;  Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan aff012;  Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan aff013;  Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan aff014;  Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan aff015;  Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan aff016;  Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan aff017;  Department of Cardiology, Kinki University Hospital, Osakasayama, Japan aff018;  Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan aff019;  Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan aff020;  Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan aff021;  Department of Cardiology, Nishikobe Medical Center, Kobe, Japan aff022;  Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan aff023;  Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan aff024;  Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan aff025;  Department of Cardiology, Hikone Municipal Hospital, Hikone, Japan aff026;  Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan aff027;  Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan aff028;  Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan aff029;  Department of Cardiology, Saiseikai Noe Hospital, Osaka, Japan aff030;  Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan aff031;  Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan aff032
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222979

Souhrn

Background

Transcatheter aortic valve implantation (TAVI) is criticized by some as an expensive treatment in super-elder patients with limited life expectancy. However, there is a knowledge gap regarding the magnitude of clinical benefit provided by TAVI in comparison with conservative management in patients with severe aortic stenosis (AS) in real clinical practice, which would be important in the decision making for TAVI.

Methods

We combined two independent registries, namely CURRENT AS and K-TAVI registries. CURRENT AS was a multicenter registry enrolling 3815 consecutive patients with severe AS irrespective to treatment modalities between January 2003 and December 2011. K-TAVI was a multicenter, prospective registry including 449 consecutive patients with severe AS, who underwent TAVI with SAPIEN XT balloon-expandable valves between October 2013 and June 2016. In these 2 registries, 449 patients received TAVI and 894 patients were managed with conservative strategy. We conducted propensity score matching and finally obtained a cohort of 556 patients (278 patients for each group) for the analysis. The primary outcome measures were all-cause death and heart failure (HF) hospitalization at 2-year.

Results

The cumulative 2-year incidences of all-cause death and HF hospitalization were significantly lower in the TAVI group than in the conservative group (16.8% versus 36.6%, P<0.001, and 10.7% versus 37.2%, P<0.001). After adjusting the residual confounders, TAVI reduced the risks of all-cause death (HR, 0.46; 95%CI, 0.32–0.69; P = 0.0001) and HF hospitalizations (HR, 0.25; 95%CI, 0.16–0.40; P<0.0001) compared with conservative strategy. There was no difference in the cumulative incidence of non-cardiovascular death between the 2 groups.

Conclusions

TAVI in the early Japanese experience was associated with striking risk reduction for all-cause death as well as HF hospitalization as compared with the historical cohort of patients with severe AS who were managed conservatively just before introduction of TAVI in Japan.

Klíčová slova:

Aortic valve – Death rates – Heart failure – Hemorrhage – Medical implants – Myocardial infarction – Stenosis – Endocarditis


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