目的:经导管主动脉瓣植入术(TAVI)后经常发生血小板减少,但对其影响知之甚少。我们的目的是分析发病率,临床影响,以及TAVI后获得性血小板减少的预测因素。
方法:这项回顾性多中心登记包括3913例接受TAVI的患者,其基线血小板计数≥100*109/L。获得性血小板减少症定义为TAVI后基线血小板计数减少≥50%(早期最低点≤3天,晚期最低点≥4天)。主要终点为30天全因死亡率,次要终点为手术安全性和2年全因死亡率。
结果:获得性血小板减少症的发生率为14.8%(早期最低点:61.5%,最低点:38.5%)。112例(3.0%)患者的30天死亡率明显高于血小板减少症患者(8.5%vs2.0%,调整或,2.3;95CI,1.3-4.2)。血小板减少症患者的手术安全性较低,2年死亡率较高(47.9vs33.0%;P<.001,30.2%vs16.8%;HR,2.2,95%IC,1.3-2.7),尤其是在最低点血小板减少症晚期(54.2%对45.5%;P=.056和38.6%对23.8%,HR,2.1;95CI,1.5-2.9)。血小板减少症的独立预测因素包括基线和手术因素,如体表面积,没有糖尿病,肾功能较差,外周血管疾病,非股动脉入路,血管并发症,经导管心脏瓣膜的类型,和早期的TAVI程序。
结论:获得性血小板减少症在TAVI后很常见(15%),并与短期和中期死亡率增加和手术安全性降低相关。此外,与早期血小板减少相比,晚期血小板减少与显著更差的临床结局相关.需要进一步的研究来阐明这些发现背后的病因机制。
OBJECTIVE: Thrombocytopenia frequently occurs after transcatheter aortic valve implantation (TAVI) but its impact is poorly understood. We aimed to analyze the incidence, clinical impact, and predictors of acquired thrombocytopenia after TAVI.
METHODS: This retrospective multicenter registry included 3913 patients undergoing TAVI with a baseline platelet count of ≥ 100 *109/L. Acquired thrombocytopenia was defined as a decrease in baseline platelet count of ≥ 50% (early nadir ≤ 3 days and late nadir ≥ 4 days) post-TAVI. The primary endpoint was 30-day all-cause mortality and secondary endpoints were procedural safety and 2-year all-cause mortality.
RESULTS: The incidence of acquired thrombocytopenia was 14.8% (early nadir: 61.5%, late nadir: 38.5%). Thirty-day mortality occurred in 112 (3.0%) patients and was significantly higher in those with thrombocytopenia (8.5% vs 2.0%, adjusted OR, 2.3; 95%CI, 1.3-4.2). Procedural safety was lower and 2-year mortality was higher in patients with thrombocytopenia vs those without (47.9 vs 33.0%; P < .001, and 30.2% vs 16.8%; HR, 2.2, 95%IC, 1.3-2.7) and especially in those with late nadir thrombocytopenia (54.2% vs 45.5%; P = .056, and 38.6% vs 23.8%, HR, 2.1; 95%CI, 1.5-2.9). Independent predictors of thrombocytopenia comprised baseline and procedural factors such as body surface area, absence of diabetes, poorer renal function, peripheral vascular disease, nontransfemoral access, vascular complications, type of transcatheter heart valve, and earlier TAVI procedures.
CONCLUSIONS: Acquired thrombocytopenia was common (15%) after TAVI and was associated with increased short- and mid-term mortality and decreased procedural safety. Moreover, late thrombocytopenia compared with early thrombocytopenia was associated with significantly worse clinical outcomes. Further investigations are needed to elucidate the etiologic mechanisms behind these findings.