RESUMEN
BACKGROUND: Few data exist on the clinical impact of transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis and a high surgical risk. The aim of this study was to determine the survival and the factors predicting mortality after 30 days post-TAVI with the CoreValve prosthesis (Medtronic, Minneapolis, MN). METHODS: From April 2008 to October 2010, the CoreValve prosthesis (Medtronic) was implanted in 133 consecutive high-risk surgical patients with symptomatic severe aortic stenosis. RESULTS: The mean age was 79.5 ± 6.7 years. The logistic European System for Cardiac Operative Risk Evaluation was 21.5% ± 14%. The implantation success rate was 97.7%. In-hospital mortality was 4.5%, and the combined end point of death, vascular complications, myocardial infarction, or stroke had a rate of 9%. Survival at 12 and 24 months was 84.5% and 79%, respectively, after a mean follow-up of 11.3 ± 8 months. The New York Heart Association functional class improved from 3.3 ± 0.5 to 1.18 ± 0.4 and remained stable at 1 year. A high Charlson index (hazard ratio [HR] 1.44, 95% CI 1.09-1.89, P < .01) and a worse Karnofsky score before the procedure (HR 0.95, 95% CI 0.92-0.99, P = .021) were predictors of mortality after 30 days. CONCLUSIONS: Transcatheter aortic valve implantation with the CoreValve prosthesis for patients with aortic stenosis and a high surgical risk is a safe, efficient option resulting in a medium-term clinical improvement. Survival during follow-up depends on the associated comorbidities. Early mortality beyond 30 days is predicted by preoperative comorbidity scores and the functional status of the patient.
Asunto(s)
Estenosis de la Válvula Aórtica/mortalidad , Cateterismo Cardíaco/métodos , Prótesis Valvulares Cardíacas , Anciano , Estenosis de la Válvula Aórtica/cirugía , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Pronóstico , Diseño de Prótesis , Factores de Riesgo , Índice de Severidad de la Enfermedad , España/epidemiología , Tasa de Supervivencia/tendencias , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Cardiomiopatía Dilatada/patología , Ecocardiografía/instrumentación , Insuficiencia de la Válvula Mitral/patología , Músculos Papilares/patología , Terapia de Resincronización Cardíaca , Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/terapia , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/terapia , Músculos Papilares/diagnóstico por imagenRESUMEN
BACKGROUND: Clinical practice guidelines recommend ad hoc screening of diabetes in patients admitted for macrovascular disease; however, these recommendations are rarely followed in real practice. This study was undertaken to assess whether impaired glucose metabolism, newly diagnosed after percutaneous coronary intervention (PCI) or known diabetes, provides prognostic information. METHODS: We studied 374 patients who underwent PCI. An oral glucose tolerance test was carried out in the known non-diabetic patients with fasting glucose < 7 mmol/L. RESULTS: Eighty-one percent of the patients presented impaired glucose metabolism, from which 35.3% were previously diagnosed with diabetics, 21.4% were newly detected diabetics, and 24.3% were pre-diabetics. After a mean follow-up of 35.8 ± 13.4 months, only a known history of diabetes was an independent predictor of revascularization (OR = 2.03, p = 0.025), non-fatal acute myocardial infarction (OR = 2.70, p = 0.029) and readmission due to heart failure during the follow-up (OR = 3.82, p = 0.022). CONCLUSIONS: Screening for impaired glucose metabolism after PCI permits the detection of a high proportion of patients with abnormal glucose regulations. However, previously known diabetes remains the only independent predictor of cardiovascular events in the follow-up.
Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus/etiología , Isquemia Miocárdica/terapia , Intervención Coronaria Percutánea/efectos adversos , Estado Prediabético/etiología , Anciano , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Ayuno/sangre , Femenino , Prueba de Tolerancia a la Glucosa , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/terapia , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/etiología , Infarto del Miocardio/terapia , Isquemia Miocárdica/diagnóstico , Oportunidad Relativa , Readmisión del Paciente , Estado Prediabético/sangre , Estado Prediabético/diagnóstico , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Estenosis de la Válvula Aórtica/mortalidad , Cateterismo Cardíaco/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Prótesis Valvulares Cardíacas , Falla de Prótesis , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/cirugía , Cateterismo Cardíaco/efectos adversos , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Incidencia , Masculino , Falla de Prótesis/efectos adversos , Tasa de Supervivencia/tendencias , Resultado del TratamientoAsunto(s)
Estenosis de la Válvula Aórtica/terapia , Cateterismo Cardíaco , Implantación de Prótesis de Válvulas Cardíacas , Índice de Severidad de la Enfermedad , Disfunción Ventricular Izquierda/terapia , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/fisiopatología , Cateterismo Cardíaco/métodos , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Volumen Sistólico/fisiología , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
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