New-onset atrial fibrillation (RR 1.85, p=0.005), chronic kidney disease, female sex, and early center experience were significant predictors of 30-day cerebrovascular events post-TAVR.
Systematic Review (n=72,318)
Yes
Relative Risk: 1.85
p-value: p=0.005
BACKGROUND: Identifying transcatheter aortic valve replacement (TAVR) patients at high risk for cerebrovascular events (CVE) is of major clinical relevance. However, predictors have varied across studies. OBJECTIVES: The purpose of this study was to analyze the predictors of 30-day CVE post-TAVR. METHODS: A systematic review of studies that reported the incidence of CVE post-TAVR while providing raw data for predictors of interest was performed. Data on study, patient, and procedural characteristics were extracted. Crude risk ratios (RRs) and 95% confidence intervals for each predictor were calculated. RESULTS: Sixty-four studies involving 72,318 patients (2,385 patients with a CVE within 30 days post-TAVR) were analyzed. Incidence of CVE ranged from 1% to 11% (median 4%) without significant differences between single and multicenter studies, or according to CVE adjudication availability. The summary RRs indicated lower risk for men (RR: 0.82; p = 0.02) and higher risk for patients with chronic kidney disease (RR: 1.29; p = 0.03) and with new-onset atrial fibrillation post-TAVR (RR: 1.85; p = 0.005), and for procedures performed within the first half of center experience (RR: 1.55; p = 0.003). The use of balloon post-dilation tended to be associated with a higher risk of CVE (RR: 1.43; p = 0.07). Valve type (balloon-expandable vs. self-expandable, p = 0.26) and approach (transfemoral vs. nontransfemoral, p = 0.81) did not predict CVE. CONCLUSIONS: Female sex, chronic kidney disease, enrollment date, and new-onset atrial fibrillation were predictors of CVE post-TAVR. This study provides effect estimates to identify high-risk TAVR patients for early CVE, providing possible guidance for tailored preventive strategies.
“This study provides effect estimates to identify high-risk TAVR patients for early CVE, providing possible guidance for tailored preventive strategies.”
Auffret et al. (Mon,) conducted a systematic review in Aortic Stenosis (n=72,318). New-onset atrial fibrillation vs. No new-onset atrial fibrillation was evaluated on 30-day cerebrovascular events (CVE) (RR 1.85, p=0.005). New-onset atrial fibrillation (RR 1.85, p=0.005), chronic kidney disease, female sex, and early center experience were significant predictors of 30-day cerebrovascular events post-TAVR.