PDF(Pubmed)
Abstract：
BACKGROUND: Transcatheter patent foramen ovale (PFO) occluder device is a procedure mostly performed to prevent secondary stroke as a result of paradoxical emboli traversing an intracardiac defect into the systemic circulation. The complications and outcomes following the procedure remain poorly studied. We aimed to investigate morbidity and mortality associated with occluder device procedures using hospital frailty index score stratification.
METHODS: The Nationwide Readmission Database was employed to identify patients admitted for PFO closure from 2016 to 2020. Two groups divided by index frailty score were compared to report adjusted odds ratio (aOR) for primary and secondary cardiovascular outcomes. Outcomes included in-hospital mortality, acute kidney injury, acute ischemic stroke, and post-procedure bleeding. Statistical analysis was performed using STATA v.17.
RESULTS: Of the 2,063 total patients who underwent the procedure, 45% possessed intermediate to high frailty scores while the other 55% had low frailty scores. The first cohort had higher odds of in-hospital mortality (aOR 6.3, 95% CI 2.05-19.5), acute kidney injury (aOR 17.6, 95% CI 9.5-32.5), and stroke (aOR 3.05, 95% CI 1.5-5.8) than the second cohort. There was no difference in the incidence of post-procedural bleeding and cardiac tamponade and 30/90/180-day readmission rates between the two cohorts. Hospitalizations in the first cohort were associated with a higher median length of stay and total cost.
CONCLUSIONS: High to intermediate frailty scores may predict an increased risk of in-hospital mortality in patients undergoing PFO occluder device procedures.
METHODS: The Nationwide Readmission Database was employed to identify patients admitted for PFO closure from 2016 to 2020. Two groups divided by index frailty score were compared to report adjusted odds ratio (aOR) for primary and secondary cardiovascular outcomes. Outcomes included in-hospital mortality, acute kidney injury, acute ischemic stroke, and post-procedure bleeding. Statistical analysis was performed using STATA v.17.
RESULTS: Of the 2,063 total patients who underwent the procedure, 45% possessed intermediate to high frailty scores while the other 55% had low frailty scores. The first cohort had higher odds of in-hospital mortality (aOR 6.3, 95% CI 2.05-19.5), acute kidney injury (aOR 17.6, 95% CI 9.5-32.5), and stroke (aOR 3.05, 95% CI 1.5-5.8) than the second cohort. There was no difference in the incidence of post-procedural bleeding and cardiac tamponade and 30/90/180-day readmission rates between the two cohorts. Hospitalizations in the first cohort were associated with a higher median length of stay and total cost.
CONCLUSIONS: High to intermediate frailty scores may predict an increased risk of in-hospital mortality in patients undergoing PFO occluder device procedures.
摘要：
背景：经导管卵圆孔未闭（PFO）封堵器装置是一种主要用于防止由于矛盾的栓塞穿过心内缺损进入体循环而导致的继发性中风的手术。手术后的并发症和结果仍然缺乏研究。我们旨在使用医院脆弱指数评分分层来调查与封堵器程序相关的发病率和死亡率。
方法：采用全国再入院数据库来确定2016年至2020年因PFO封堵而入院的患者。将两组按指标虚弱评分进行比较，以报告原发性和继发性心血管结局的校正比值比（aOR）。结果包括住院死亡率，急性肾损伤，急性缺血性卒中,以及术后出血.使用STATAv.17进行统计分析。
结果：在接受手术的2,063名患者中，45％的人具有中等至高的脆弱分数，而其他55％的人具有低的脆弱分数。第一个队列的住院死亡率较高（aOR6.3，95％CI2.05-19.5），急性肾损伤（aOR17.6，95%CI9.5-32.5），和卒中（aOR3.05，95%CI1.5-5.8）比第二队列。两组术后出血和心包填塞的发生率以及30/90/180天的再入院率没有差异。第一队列中的住院与较高的中位住院时间和总费用相关。
结论：在接受PFO封堵器手术的患者中，从高到中等的虚弱评分可能预示着院内死亡风险的增加。
方法：采用全国再入院数据库来确定2016年至2020年因PFO封堵而入院的患者。将两组按指标虚弱评分进行比较，以报告原发性和继发性心血管结局的校正比值比（aOR）。结果包括住院死亡率，急性肾损伤，急性缺血性卒中,以及术后出血.使用STATAv.17进行统计分析。
结果：在接受手术的2,063名患者中，45％的人具有中等至高的脆弱分数，而其他55％的人具有低的脆弱分数。第一个队列的住院死亡率较高（aOR6.3，95％CI2.05-19.5），急性肾损伤（aOR17.6，95%CI9.5-32.5），和卒中（aOR3.05，95%CI1.5-5.8）比第二队列。两组术后出血和心包填塞的发生率以及30/90/180天的再入院率没有差异。第一队列中的住院与较高的中位住院时间和总费用相关。
结论：在接受PFO封堵器手术的患者中，从高到中等的虚弱评分可能预示着院内死亡风险的增加。
