期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 76, 期 8, 页码 985-991出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2020.05.085
关键词
clinical trials; guidelines; evidence; TAVR; SAVR
On August 16, 2019, the U.S. Food and Drug Administration approved expanding the indication for transcatheter aortic valve replacement (TAVR) to low-risk patients with symptomatic severe aortic stenosis. The decision was based on the results of 2 pivotal trials that confirmed superiority (PARTNER [Placement of Aortic Transcatheter Valves] 3) or noninferiority (Evolut Low Risk [LR]) of TAVR as compared with SAVR at 1- and 2-year follow-up, respectively. As compared with intermediate-risk cohorts, the sample size in these trials was smaller and the total number of primary endpoint events was nearly 3 times as low (193 vs. 615). The total number of deaths from any cause or disabling stroke at 1 year in the low-risk cohorts was 62, which is substantially lower than the numbers in intermediate-, high-, and inoperable-risk cohorts. In Evolut LR, only 137 of 1,403 patients (9.8%) completed the 2-year follow-up, with 91.2% requiring modelbased imputation. Thus, the quantum of evidence is insufficient for endorsing TAVR as the preferred intervention for these patients. (C) 2020 by the American College of Cardiology Foundation.
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