根据DapaTAVI试验中的衰弱状态评估经导管主动脉瓣植入术后达格列净的应用。
完整摘要 · 中文译文
背景：衰弱在接受经导管主动脉瓣植入术的重度主动脉瓣狭窄患者中很常见，并预示更差的结局。经导管主动脉瓣植入术后达格列净的获益是否因衰弱而异尚不确定。 方法：在这项事后分析中，我们根据DapaTAVI（达格列净用于接受经导管主动脉瓣植入术的患者）试验中的衰弱状态探讨了达格列净的疗效。衰弱通过疲劳、阻力、行走、疾病和体重减轻量表进行评估（健壮=0，衰弱前期=1-2，衰弱=3-5）。主要结局为1年时全因死亡或心力衰竭恶化的复合终点。 结果：在1222例有基线衰弱评估的患者中，47.2%为衰弱，40.3%为衰弱前期，12.4%为健壮。在12个月内，215例患者（17.6%）发生了主要终点。衰弱前期和衰弱患者的风险高于健壮患者（校正风险比[HR]分别为1.88[95%CI，1.05-3.38]和2.29[1.29-4.07]；P=0.004）。达格列净与衰弱患者主要终点风险降低相关（HR，0.53[95%CI，0.36-0.77]），但在衰弱前期患者（HR，1.01[95%CI，0.66-1.55]）或健壮患者（HR，1.26[95%CI，0.42-3.75]）中则不然；交互作用P=0.021。没有证据表明衰弱改变了达格列净的安全性特征。 结论：衰弱很常见，且与经导管主动脉瓣植入术后更差的结局独立相关。达格列净似乎赋予更大的相对 （对于）衰弱患者有生存获益。
完整摘要 · 英文原文
BACKGROUND: Frailty is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and portends worse outcomes. Whether the benefit of posttranscatheter aortic valve implantation dapagliflozin differs by frailty is uncertain. METHODS: In this post hoc analysis, we investigated the efficacy of dapagliflozin according to frailty status in the DapaTAVI (Dapagliflozin in Patients Undergoing Transcatheter Aortic Valve Implantation) trial. Frailty was assessed through the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale (robust=0, prefrail=1-2, frail=3-5). The primary outcome was the composite of all-cause death or worsening heart failure at 1 year. RESULTS: Among 1222 patients with baseline frailty assessment, 47.2% were frail, 40.3% prefrail, and 12.4% robust. Over 12 months, 215 patients (17.6%) experienced the primary end point. Patients who were prefrail and frail had higher risk than robust patients (adjusted hazard ratios [HRs], 1.88 [95% CI, 1.05-3.38] and 2.29 [1.29-4.07], respectively; P=0.004). Dapagliflozin was associated with a lower risk of the primary end point in patients who were frail (HR, 0.53 [95% CI, 0.36-0.77]) but not in those who were prefrail (HR, 1.01 [95% CI, 0.66-1.55]) or robust patients (HR, 1.26 [95% CI, 0.42-3.75]); P for interaction=0.021. There was no evidence that frailty modified the safety profile of dapagliflozin. CONCLUSIONS: Frailty was common and independently associated with worse outcomes after transcatheter aortic valve implantation. Dapagliflozin appeared to confer greater relative benefit in patients with frailty.