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Abstract：
BACKGROUND: Chronic inflammatory disease (CID) accelerates atherosclerosis and the development of aortic stenosis. Data on long-term outcomes after transcatheter aortic valve implantation (TAVI) in those patients are missing. The aim of this study was to investigate the clinical long-term outcomes of patients with and without autoimmune-related CID undergoing TAVI for the treatment of severe aortic stenosis.
RESULTS: From a prospective registry, consecutive patients with TAVI were included. Baseline clinic and imaging data (echocardiographic and computed tomography) were analyzed. Long-term (up to 5 years) clinical and echocardiographic outcomes were studied. Of 1000 consecutive patients (mean age 81±6 years, 46% female), 107 (11%) had CID; the most frequent entities included polymyalgia rheumatica (31%) and rheumatoid arthritis (28%). Patients with CID were predominantly female (60% versus 44%, P=0.002) and more often had pulmonary disorders (21% versus 13%, P=0.046) and atrial fibrillation (32% versus 20%, P=0.003). The presence of CID was associated with a higher rate of postinterventional infection (5% versus 1%, P=0.007) and further emerged as a risk factor for rehospitalization for bleeding or infection (hazard ratio, 1.93 and 1.62, respectively). Premature valve degeneration, endocarditis, and all-cause mortality were not increased among patients with CID.
CONCLUSIONS: This real-world analysis found that patients with CID undergoing TAVI were associated with a higher risk of postinterventional infectious complications and rehospitalization due to infection. However, valve durability and survival seem not to differ between patients with TAVI with versus without CID.
RESULTS: From a prospective registry, consecutive patients with TAVI were included. Baseline clinic and imaging data (echocardiographic and computed tomography) were analyzed. Long-term (up to 5 years) clinical and echocardiographic outcomes were studied. Of 1000 consecutive patients (mean age 81±6 years, 46% female), 107 (11%) had CID; the most frequent entities included polymyalgia rheumatica (31%) and rheumatoid arthritis (28%). Patients with CID were predominantly female (60% versus 44%, P=0.002) and more often had pulmonary disorders (21% versus 13%, P=0.046) and atrial fibrillation (32% versus 20%, P=0.003). The presence of CID was associated with a higher rate of postinterventional infection (5% versus 1%, P=0.007) and further emerged as a risk factor for rehospitalization for bleeding or infection (hazard ratio, 1.93 and 1.62, respectively). Premature valve degeneration, endocarditis, and all-cause mortality were not increased among patients with CID.
CONCLUSIONS: This real-world analysis found that patients with CID undergoing TAVI were associated with a higher risk of postinterventional infectious complications and rehospitalization due to infection. However, valve durability and survival seem not to differ between patients with TAVI with versus without CID.
摘要：
背景：慢性炎性疾病（CID）加速动脉粥样硬化和主动脉瓣狭窄的发展。这些患者经导管主动脉瓣植入术（TAVI）后的长期结果数据缺失。这项研究的目的是研究接受TAVI治疗严重主动脉瓣狭窄的有或没有自身免疫性相关CID的患者的临床长期预后。
结果：从前瞻性注册表中，纳入了连续的TAVI患者.分析了基线临床和影像学数据（超声心动图和计算机断层扫描）。研究了长期（长达5年）临床和超声心动图结果。在1000名连续患者中（平均年龄81±6岁，46％女性），107（11％）有CID；最常见的实体包括风湿性多肌痛（31％）和类风湿性关节炎（28％）。CID患者以女性为主(60%对44%，P=0.002）和更常见的肺部疾病（21%对13%，P=0.046)和心房颤动(32%对20%，P=0.003)。CID的存在与较高的介入后感染率相关(5%对1%，P=0.007），并进一步成为出血或感染再住院的危险因素（风险比，分别为1.93和1.62）。瓣膜过早变性,心内膜炎,CID患者的全因死亡率没有增加
结论：这项实际分析发现，接受TAVI的CID患者与介入后感染并发症和因感染而再次住院的风险较高相关。然而,TAVI患者的瓣膜耐久性和生存率似乎没有差异。
结果：从前瞻性注册表中，纳入了连续的TAVI患者.分析了基线临床和影像学数据（超声心动图和计算机断层扫描）。研究了长期（长达5年）临床和超声心动图结果。在1000名连续患者中（平均年龄81±6岁，46％女性），107（11％）有CID；最常见的实体包括风湿性多肌痛（31％）和类风湿性关节炎（28％）。CID患者以女性为主(60%对44%，P=0.002）和更常见的肺部疾病（21%对13%，P=0.046)和心房颤动(32%对20%，P=0.003)。CID的存在与较高的介入后感染率相关(5%对1%，P=0.007），并进一步成为出血或感染再住院的危险因素（风险比，分别为1.93和1.62）。瓣膜过早变性,心内膜炎,CID患者的全因死亡率没有增加
结论：这项实际分析发现，接受TAVI的CID患者与介入后感染并发症和因感染而再次住院的风险较高相关。然而,TAVI患者的瓣膜耐久性和生存率似乎没有差异。
