Key result
In patients undergoing TAVR, underlying carotid artery disease was not associated with increased in-hospital mortality (3.8% vs 4.9%, p=0.34) or post-procedural stroke (3.1% vs 3.5%, p=0.75).
Why the study?
Stroke is a morbid complication after TAVR, but the role of underlying carotid disease in predicting it is unknown.
Does underlying carotid disease increase the risk of post-procedural stroke and other complications in patients undergoing TAVR?
Cohort (n=1,272)
Yes
Does underlying carotid disease increase the risk of post-procedural stroke and other complications in patients undergoing TAVR?
Absolute Event Rate: 3.8% vs 4.9%
p-value: p=0.34
Underlying carotid disease does not appear to significantly increase the risk of in-hospital post-procedural stroke or mortality in patients undergoing TAVR.
Underlying carotid disease may not elevate TAVR in-hospital risks; leaves open whether targeted screening improves outcomes.
Background Stroke is a morbid complication following transcatheter aortic valve replacement (TAVR), and the role of underlying carotid disease (CD) in predicting this complication is unknown. This study was undertaken to evaluate outcomes after TAVR in patients with and without CD. Methods The study population was extracted from the 2014 Nationwide Readmissions Data (NRD) using International Classification of Disease Ninth-Clinical Modification (ICD-9-CM) codes for TAVR, CD and post-procedural complications to extract the exposure group of TAVR patients with a history of CD. Propensity score matching was used to extract a matched control group (TAVR-C). Study endpoints included all-cause in-hospital mortality, length of stay (LOS), post-procedural stroke, acute myocardial infarction (AMI), acute renal failure (ARF), bleeding, mechanical complications of prosthetic valve, vascular complications (VC), need for a new permanent pacemaker (PPM), and 30-day readmission rates. Results A total of 636 discharges were included in each group. Both groups were comparable in terms of baseline characteristics and comorbidities. Mean age was 81.1 years and 45% were female. There was no significant difference in all-cause in-hospital mortality (3.8% versus 4.9%, p = 0.34), LOS (8.5 vs. 9.3 days, p = 0.12), post-procedural stroke (3.1% vs. 3.5%, p = 0.75), AMI (3.1% vs. 3.5%, p = 0.75), ARF (18.9% versus 17.5%, p = 0.51), bleeding (36.5% vs. 35.1%, p = 0.59), mechanical complications of prosthetic valve (1.1% vs. 0.8%, p = 0.56), VC (3.8% vs. 4.1%, p = 0.78), PPM (8.0% vs. 9.8%, p = 0.30) or 30-day readmission rate (20.7% vs. 23.8%, p = 0.62). Conclusion Compared to TAVR-C, TAVR-CD was associated with comparable in-hospital post-procedural stroke and other outcomes.
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Enezate et al. (2019) conducted a cohort in Transcatheter aortic valve replacement (TAVR) with carotid artery disease (n=1,272). Carotid artery disease vs. No carotid artery disease was evaluated on All-cause in-hospital mortality (p=0.34). In patients undergoing TAVR, underlying carotid artery disease was not associated with increased in-hospital mortality (3.8% vs 4.9%, p=0.34) or post-procedural stroke (3.1% vs 3.5%, p=0.75).
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