Reports about the application of transcatheter aortic valve replacement (TAVR) for patients with aortic stenosis, whose valve sizes exceed the maximum recommended annular diameter of the largest artificial valve, is rarely in China. This paper reports an aortic stenosis patient characterized by large aortic annulus diameter with severe calcification and treated by TAVR. A comprehensive and careful operation plan was made before the operation. The anterior and posterior balloon dilatation and coronary artery protection were used during the operation. The patient was followed up for 2 years and was in stable condition.
Objective To explore the risk factors for long-term death of patients with acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (LVEF), and develop and validate a prediction model for long-term death. Methods This retrospective cohort study included 1013 patients diagnosed with AMI and reduced LVEF in West China Hospital of Sichuan University between January 2010 and June 2019. Using the RAND function of Excel software, patients were randomly divided into three groups, two of which were combined for the purpose of establishing the model, and the third group was used for validation of the model. The endpoint of the study was all-cause mortality, and the follow-up was until January 20th, 2021. Cox proportional hazard model was used to evaluate the risk factors affecting the long-term death, and then a prediction model based on those risk factors was established and validated. Results During a median follow-up of 1377 days, 296 patients died. Multivariate Cox regression analysis showed that age≥65 years [hazard ratio (HR)=1.842, 95% confidence interval (CI) (1.067, 3.179), P=0.028], Killip class≥Ⅲ[HR=1.941, 95%CI (1.188, 3.170), P=0.008], N-terminal pro-brain natriuretic peptide≥5598 pg/mL [HR=2.122, 95%CI (1.228, 3.665), P=0.007], no percutaneous coronary intervention [HR=2.181, 95%CI (1.351, 3.524), P=0.001], no use of statins [HR=2.441, 95%CI (1.338, 4.454), P=0.004], and no use of β-blockers [HR=1.671, 95%CI (1.026, 2.720), P=0.039] were independent risk factors for long-term death. The prediction model was established and patients were divided into three risk groups according to the total score, namely low-risk group (0-2), medium-risk group (4-6), and high-risk group (8-12). The results of receiver operating characteristic curve [area under curve (AUC)=0.724, 95%CI (0.680, 0.767), P<0.001], Hosmer-Lemeshow test (P=0.108), and Kaplan-Meier survival curve (P<0.001) showed that the prediction model had an efficient prediction ability, and a strong ability in discriminating different groups. The model was also shown to be valid in the validation group [AUC=0.758, 95%CI (0.703, 0.813), P<0.001]. Conclusions In patients with AMI and reduced LVEF, age≥65 years, Killip class≥Ⅲ, N-terminal pro-brain natriuretic peptide≥5598 pg/mL, no percutaneous coronary intervention, no use of statins, and no use of β-blockers are independent risk factors for long-term death. The developed risk prediction model based on these risk factors has a strong prediction ability.