Key result
TAVI-related ischaemic stroke was associated with a higher risk of a 1-year composite of all-cause mortality, acute myocardial infarction, and subsequent stroke (HR 1.67; 95% CI 1.56-1.78).
Why the study?
Despite safety improvements in TAVI, approximately 4% of patients experience procedure-related stroke, and understanding its long-term health and healthcare implications could motivate preventative strategies.
Does TAVI-related ischaemic stroke worsen 1-year clinical outcomes and increase healthcare utilization in patients undergoing TAVI?
Cohort (n=129,628)
Yes
Does TAVI-related ischaemic stroke worsen 1-year clinical outcomes and increase healthcare utilization in patients undergoing TAVI?
Hazard Ratio: 1.67 (95% CI 1.56–1.78)
Procedure-related ischaemic stroke during TAVI is associated with significantly worse 1-year clinical outcomes, increased healthcare costs, and less time spent at home.
TAVI-related stroke signals need for intensified secondary prevention; extends evidence on its adverse prognostic impact in large cohorts.
BACKGROUND: Despite improvements in the safety of transcatheter aortic valve implantation (TAVI), ~4% of patients experience a procedure-related stroke. Understanding long-term health and healthcare implications of these events may motivate the development and adoption of preventative strategies. Aims: We aimed to assess the association of TAVI-related ischaemic stroke with subsequent clinical outcomes and healthcare utilisation. METHODS: We used Medicare fee-for-service claims to identify patients who underwent their first TAVI between January 2012 and December 2017. Previously used ICD-9-CM and ICD-10-CM codes were used to identify TAVI-related ischaemic stroke. Among those with and without TAVI-related ischaemic stroke, we compared the risk of a composite endpoint that included all-cause mortality, acute myocardial infarction, and subsequent stroke using inverse probability treatment weighted Cox regression. We also performed a difference-in-difference analysis to compare 1-year Medicare expenditures and days spent at home during the first year after TAVI. RESULTS: Among 129,628 primary TAVI patients, 5,549 (4.3%) had a procedure-related stroke. These patients were more likely to be female and have had prior stroke, peripheral vascular disease, ischaemic heart disease, or renal failure. After adjustment, TAVI-related ischaemic stroke was associated with a higher risk of the 1-year composite outcome (HR 1.67, 95% CI: 1.56-1.78), higher 1-year Medicare expenditures (difference $9,245 [standard error 790], p<0.001), and fewer days at home during the first year (difference 16 days [standard error 1], p<0.001). CONCLUSIONS: Among Medicare beneficiaries undergoing TAVI, procedure-related ischaemic stroke was associated with worse outcomes, increased Medicare expenditures, and less time spent at home. Procedure-related ischaemic stroke during TAVI remains a critically important and potentially preventable source of patient mortality, morbidity and healthcare utilisation.
No takes yet. Share an insight, caveat, or question.
Almarzooq et al. (2022) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=129,628). TAVI-related ischaemic stroke vs. No TAVI-related ischaemic stroke was evaluated on Composite endpoint that included all-cause mortality, acute myocardial infarction, and subsequent stroke (HR 1.67, 95% CI 1.56-1.78). TAVI-related ischaemic stroke was associated with a higher risk of a 1-year composite of all-cause mortality, acute myocardial infarction, and subsequent stroke (HR 1.67; 95% CI 1.56-1.78).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: