In‐hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis

Aung Myat; Luke Buckner; Florence Mouy; James Cockburn; Andreas Baumbach; Adrian Banning; Daniel J. Blackman; Nick Curzen; Philip MacCarthy; Michael Mullen; Mark de Belder; Ian Cox; Jan Kovac; Stephen Brecker; Mark Turner; Saib Khogali; Iqbal Malik; Osama Alsanjari; Simon Redwood; Bernard Prendergast; Uday Trivedi; Derek Robinson; Peter Ludman; Adam de Belder; David Hildick‐Smith

doi:10.1002/ccd.29157

Why the study?

Stroke is a recognized complication of TAVI, but established predictors of procedure-related in-hospital stroke remain poorly defined.

What are the independent predictors of in-hospital stroke following transcatheter aortic valve implantation (TAVI)?

Key Points

Identify baseline demographics and procedural factors that independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI).
Observational cohort analysis using data from the multicenter UK TAVI registry between 2007 and 2015 (N=8,652).
Assessed predictors and mortality implications for the primary endpoint of in-hospital stroke incidence.
In-hospital stroke occurred in 2.4% of procedures (205/8,652), with lower incidence observed for balloon-expandable valves (2.08% [96/4,613]) than self-expandable valves (2.90% [95/3,272]; p=0.020).
Multivariable analysis linked stroke to prior cerebrovascular disease (OR 1.51, 95% CI 1.05–2.17; p=0.03), older age (OR 1.02, 95% CI 0.10–1.04; p=0.05), bailout coronary stenting (OR 5.94, 95% CI 2.03–17.39; p=0.008), and earlier procedure year (OR 0.93, 95% CI 0.87–1.00; p=0.04), while prior cardiac surgery (OR 0.62, 95% CI 0.41–0.93; p=0.01) and balloon-expandable valves (OR 0.72, 95% CI 0.53–0.97; p=0.03) showed lower risk.
In-hospital stroke significantly increased 30-day mortality (OR 5.22, 95% CI 3.49–7.81; p<0.001) and 1-year mortality (OR 3.21, 95% CI 2.15–4.78; p<0.001).

Structured PICO

What are the independent predictors of in-hospital stroke following transcatheter aortic valve implantation (TAVI)?

P

Population

8,652 patients undergoing transcatheter aortic valve implantation (TAVI) procedures from 2007 to 2015 in the multicenter UK TAVI registry.

I

Intervention

Transcatheter aortic valve implantation (TAVI)

O

Outcome

Incidence of in-hospital strokehard clinical

In-hospital stroke after TAVI is a rare but severe complication (2.4% incidence) associated with increased mortality, with risk factors including prior cerebrovascular disease, advanced age, and bailout coronary stenting.

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Implication

Associated risk factors support enhanced pre-TAVI evaluation; leaves open prospective validation before guiding practice.

Abstract

OBJECTIVES: We sought to identify baseline demographics and procedural factors that might independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI). BACKGROUND: Stroke is a recognized, albeit infrequent, complication of TAVI. Established predictors of procedure-related in-hospital stroke; however, remain poorly defined. METHODS: We conducted an observational cohort analysis of the multicenter UK TAVI registry. The primary outcome measure was the incidence of in-hospital stroke. RESULTS: A total of 8,652 TAVI procedures were performed from 2007 to 2015. There were 205 in-hospital strokes reported by participating centers equivalent to an overall stroke incidence of 2.4%. Univariate analysis showed that the implantation of balloon-expandable valves caused significantly fewer strokes (balloon-expandable 96/4,613 [2.08%] vs. self-expandable 95/3,272 [2.90%]; p = .020). After multivariable analysis, prior cerebrovascular disease (CVD) (odds ratio [OR] 1.51, 95% confidence interval [CI 1.05-2.17]; p = .03), advanced age at time of operation (OR 1.02 [0.10-1.04]; p = .05), bailout coronary stenting (OR 5.94 [2.03-17.39]; p = .008), and earlier year of procedure (OR 0.93 [0.87-1.00]; p = .04) were associated with an increased in-hospital stroke risk. There was a reduced stroke risk in those who had prior cardiac surgery (OR 0.62 [0.41-0.93]; p = .01) and a first-generation balloon-expandable valve implanted (OR 0.72 [0.53-0.97]; p = .03). In-hospital stroke significantly increased 30-day (OR 5.22 [3.49-7.81]; p < .001) and 1-year mortality (OR 3.21 [2.15-4.78]; p < .001). CONCLUSIONS: In-hospital stroke after TAVI is associated with substantially increased early and late mortality. Factors independently associated with in-hospital stroke were previous CVD, advanced age, no prior cardiac surgery, and deployment of a predominantly first-generation self-expandable transcatheter heart valve.

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Cite This Study

Myat et al. (2020) studied this question.

synapsesocial.com/papers/6a026f667adabae4d9372b84 https://doi.org/10.1002/ccd.29157

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In‐hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

In‐hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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