Severe aortic atheroma doubled periprocedural ischemic stroke risk (7.0% vs 3.5%, aHR 2.01) and increased 2-year MACCE to 40.6% vs 28.9% post-TAVR.
Does severe aortic atheroma increase the risk of major adverse cardiac and cerebrovascular events in patients undergoing TAVR?
Severe aortic atheroma identified on pre-procedural CT is a significant independent predictor of 2-year MACCE, particularly periprocedural and late ischemic stroke and CV death, following TAVR.
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Abstract Backgrounds Aortic atheroma morphology is associated with acute outcomes post-transcatheter aortic valve replacement (TAVR); however, its association with long-term outcomes post-TAVR remains unknown. Purpose This study aimed to assess the influence of severe aortic atheroma on long-term outcomes post-TAVR. Methods We enrolled 977 patients who underwent TAVR between February 2010 and May 2019, with available contrast-enhanced computed tomography data. Severe aortic atheroma was defined as protruding atheroma of ≥3mm thickness with protruding components, ulcerated atheroma with ulcer-like intimal disruption, and atheroma of ≥5mm thickness (Figure 1A-1C). The primary endpoint was 2-year major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of cardiovascular (CV) death, myocardial infarction, ischemic stroke, and heart failure, which were classified as periprocedural (≤30 days), early (30 days to 1 year), and late events (1-year post-TAVR). Results Patients with severe aortic atheroma (n=274, 28%) had a higher cumulative incidence of 2-year MACCE compared with those without (40.6% vs. 28.9%, log-rank p=0.0002), which was attributed to increased risks of 2-year ischemic stroke (13.8% vs. 6.8%, log-rank p=0.0012) and CV death (18.6% vs. 10.8%, log-rank p=0.0009) (Figure 1D-1F). Severe aortic atheromas were independent risk factors for 2-year ischemic stroke (adjusted hazard ratio aHR, 1.98, 95% CI, 1.27–3.10), CV death (aHR 1.74, 95% CI 1.21–2.51), and MACCE (aHR, 1.50, 95% CI, 1.18–1.91). In the landmark analysis, patients with severe aortic atheroma had a higher cumulative incidence of periprocedural MACCE (16.4% vs. 7.3%, long-rank p0.0001), whereas there was no significant difference in early and late MACCE between the two groups (17.9% vs. 15.0%, long-rank p=0.31 and 13.4% vs. 9.9%, long-rank p=0.21, respectively) (Figure 2A). Severe aortic atheroma was also independent risk factors for periprocedural MACCE (aHR, 2.15, 95% CI, 1.42–3.25), not early and late MACCE (aHR 1.13, 95% CI, 0.77–1.65 and aHR, 1.54, 95% CI, 0.92–2.58, respectively). Patients with severe aortic atheroma also had a higher cumulative incidence of periprocedural ischemic stroke and CV death (7.0% vs. 3.5%, long-rank p=0.014 and 7.3% vs. 2.4%, long-rank p=0.0003, respectively), and late ischemic stroke (4.6% vs. 1.3%, long-rank p=0.0055) (Figure 2B and 2C). Severe aortic atheroma was independently associated with periprocedural ischemic stroke and CV death (aHR, 2.01, 95% CI, 1.10–3.68 and aHR, 2.90, 95% CI, 1.51–5.58, respectively), and late ischemic stroke (aHR, 4.00, 95% CI, 1.47–10.9). Conclusions Severe aortic atheroma is associated with an increased risk of 2-year MACCE after TAVR, reflecting periprocedural ischemic stroke and CV death, and late ischemic stroke. Severe aortic atheroma appears to be an integrative marker of several comorbidities that significantly contribute to late adverse events beyond the periprocedural phase.Figure 1 Figure 2
Kikuchi et al. (Sat,) reported a other. Severe aortic atheroma doubled periprocedural ischemic stroke risk (7.0% vs 3.5%, aHR 2.01) and increased 2-year MACCE to 40.6% vs 28.9% post-TAVR.