Key result
Cerebral embolic protection device use during TAVI was not associated with a reduced risk of in-hospital stroke or TIA compared to non-use (adjusted OR 0.99; 95% CI 0.86-1.15).
Why the study?
The effectiveness of cerebral embolic protection devices in mitigating stroke after TAVI remains uncertain, potentially leading to variable hospital-level utilization across the US.
Does the use of cerebral embolic protection devices reduce in-hospital stroke or TIA in patients undergoing nontransapical TAVI?
Observational (n=41,822)
Yes
Does the use of cerebral embolic protection devices reduce in-hospital stroke or TIA in patients undergoing nontransapical TAVI?
Answers are grounded in this paper and cite their sources.
The use of cerebral embolic protection devices during TAVI varies widely across US hospitals and is not associated with improved in-hospital neurologic outcomes, though it is associated with higher hospitalization costs.
Background: The effectiveness of cerebral embolic protection devices (CEPD) in mitigating stroke after transcatheter aortic valve implantation (TAVI) remains uncertain, and therefore CEPD may be utilized differently across US hospitals. This study aims to characterize the hospital-level pattern of CEPD use during TAVI in the US and its association with outcomes. Methods: Patients treated with nontransapical TAVI in the 2019 Nationwide Readmissions Database were included. Hospitals were categorized as CEPD non-users and CEPD users. The following outcomes were compared: the composite of in-hospital stroke or transient ischemic attack (TIA), in-hospital ischemic stroke, death, and cost of hospitalization. Logistic regression models were used for risk adjustment of clinical outcomes. Results: Of 41,822 TAVI encounters, CEPD was used in 10.6% (n = 4422). Out of 392 hospitals, 65.8% were CEPD non-user hospitals and 34.2% were CEPD users. No difference was observed between CEPD non-users and CEPD users in the risk of in-hospital stroke or TIA (adjusted odds ratio (OR) = 0.99 [0.86-1.15]), ischemic stroke (adjusted OR = 1.00 [0.85-1.18]), or in-hospital death (adjusted OR = 0.86 [0.71-1.03]). The cost of hospitalization was lower in CEPD non-users. Conclusions: Two-thirds of hospitals in the US do not use CEPD for TAVI, and no significant difference was observed in neurologic outcomes among patients treated at CEPD non-user and CEPD user hospitals.
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Ubaid et al. (2023) conducted an observational in Transcatheter aortic valve implantation (TAVI) (n=41,822). Cerebral embolic protection devices (CEPD) vs. CEPD non-users was evaluated on Composite of in-hospital stroke or transient ischemic attack (TIA) (adjusted OR 0.99, 95% CI 0.86-1.15). Cerebral embolic protection device use during TAVI was not associated with a reduced risk of in-hospital stroke or TIA compared to non-use (adjusted OR 0.99; 95% CI 0.86-1.15).
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