医学
脂蛋白(a)
阀门更换
狭窄
内科学
入射(几何)
心脏病学
主动脉瓣狭窄
冠状动脉疾病
脂蛋白
主动脉瓣置换术
主动脉瓣
血运重建
外科
胆固醇
心肌梗塞
物理
光学
作者
S. Gary,Michael J. Wilkinson,Ryan Reeves,Calvin Yeang,Anthony N. DeMaria,Bruno Cotter,Mitul Patel,Ehtisham Mahmud,Sotirios Tsimikas
出处
期刊:Angiology
[SAGE]
日期:2019-01-30
卷期号:70 (4): 332-336
被引量:10
标识
DOI:10.1177/0003319719826461
摘要
Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for calcific aortic valve stenosis (CAVS) for which transcatheter aortic valve replacement (TAVR) is increasingly utilized as treatment. We evaluated the effect of a program to increase testing of and define the prevalence of elevated Lp(a) among patients undergoing TAVR. Educational efforts and incorporation of a “check-box” Lp(a) order to the preoperative TAVR order set were instituted. Retrospective chart review was performed in 229 patients requiring TAVR between May 2013 and September 2018. Of these patients, 57% had an Lp(a) level measured; testing rates increased from 0% in 2013 to 96% in 2018. Lipoprotein(a) testing occurred in 11% of patients before and in 80% of patients after the “check-box” order set ( P < .001). The prevalence of elevated Lp(a) (≥30 mg/dL) was 35%; these patients had a higher incidence of coronary artery disease requiring revascularization compared with patients with normal Lp(a) (65% vs 47%; P = .047). Patients with Lp(a) ≥30 mg/dL also had higher incidence of paravalvular leak compared with those with normal Lp(a) (13% vs 4%; P = .04). This study defines the prevalence of elevated Lp(a) in advanced stages of CAVS and provides a practice pathway to assess procedural complications and long-term outcomes of TAVR in patients with elevated Lp(a) levels.
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