Federico Conrotto1, Fabrizio D'Ascenzo2, Augusto D'Onofrio3, Marco Agrifoglio4, Alaide Chieffo5, Micaela Cioni5, Tommaso Regesta6, Giuseppe Tarantini3, Davide Gabbieri7, Francesco Saia8, Corrado Tamburino9, Flavio Ribichini10, Diego Cugola11, Marco Aiello12, Francesco Sanna13, Alessandro Iadanza14, Esmeralda Pompei15, Miroslava Stolcova16, Antioco Cappai17, Alessandro Minati18, Mauro Cassese19, Gian Luca Martinelli19, Andrea Agostinelli20, Gino Gerosa3, Fiorenzo Gaita2, Mauro Rinaldi21, Stefano Salizzoni21. 1. Division of Cardiology, Città della Salute e della Scienza Hospital, Torino, Italy federico.conrotto@gmail.com. 2. Division of Cardiology, Città della Salute e della Scienza Hospital, Torino, Italy. 3. Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy. 4. Centro Cardiologico Monzino, Department of Clinical Sciences and Community, University of Milano, Milano, Italy. 5. Ospedale San Raffaele, Milano, Italy. 6. Divisione di Cardiochirurgia, IRCCS San Martino-IST, Genova, Italy. 7. Hesperia Hospital, Modena, Italy. 8. AOU Policlinico S. Orsola-Malpighi, Bologna, Italy. 9. Ospedale Ferrarotto, Università di Catania, Catania, Italy. 10. AOU Integrata Verona, Verona, Italy. 11. AO Papa Giovanni XXIII, Bergamo, Italy. 12. IRCCS Policinico S. Matteo, Pavia, Italy. 13. AO Brotzu, Cagliari, Italy. 14. AOU Policlinico Le Scotte, Siena, Italy. 15. AOUD Santa Maria della Misericordia, Udine, Italy. 16. AOU Careggi, Firenze, Italy. 17. Humanitas Research Hospital, Rozzano, Italy. 18. Ospedale Cattinara, Trieste, Italy. 19. Clinica S. Maria, Bari, Italy. 20. Ospedale Maggiore, Parma, Italy. 21. Department of Surgical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy.
Abstract
OBJECTIVES: Stroke incidence after transcatheter aortic valve implantation (TAVI) still represents a concern. This multicentre study aimed at investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be used to predict perioperative stroke after TAVI. METHODS: The Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a multicentre, prospective registry of patients undergoing balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis between 2007 and 2012. The primary end-point of this study was the 30-day stroke rate. Secondary safety end-points were all the major adverse events based on Valve Academic Research Consortium (VARC-2) criteria. RESULTS: One thousand nine hundred and four patients were enrolled in the registry. Mean age was 81.6 ± 6.2 years and 1147 (60.2%) patients were female; mean CHADS2 and CHA2DS2-VASc scores were 2.2 ± 0.8 and 4.4 ± 1.1, respectively. Fifty-four (2.8%) patients had a stroke within 30 days. At multivariable logistic regression analysis, CHA2DS2-VASc (OR: 1.35, 95% CI: 1.03-1.78; P = 0.031) and previous cardiac surgery (OR: 1.96, 95% CI: 1.06-3.6; P = 0.033) but not CHADS2 (OR: 1.05, 95% CI: 0.76-1.44; P = 0.77) were found to be independent predictors of in-hospital stroke. A CHA2DS2-VASc score ≥5 was strongly related to the occurrence of in-hospital stroke (OR: 2.51, 95% CI: 1.38-4.57; P= 0.001). However, CHA2DS2-VASc score showed only poor accuracy for in-hospital stroke with a trend for better accuracy when compared with CHADS2 score (area under the curve: 0.61, 95% CI: 0.59-0.63 vs 0.51; 95% CI: 0.49-0.54, respectively, P = 0.092). CONCLUSIONS: In TAVI patients, CHA2DS2-VASc provided a strong correlation for in-hospital stroke but with low accuracy. Dedicated scores to properly tailor procedures and preventive strategies are needed.
OBJECTIVES:Stroke incidence after transcatheter aortic valve implantation (TAVI) still represents a concern. This multicentre study aimed at investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be used to predict perioperative stroke after TAVI. METHODS: The Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a multicentre, prospective registry of patients undergoing balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis between 2007 and 2012. The primary end-point of this study was the 30-day stroke rate. Secondary safety end-points were all the major adverse events based on Valve Academic Research Consortium (VARC-2) criteria. RESULTS: One thousand nine hundred and four patients were enrolled in the registry. Mean age was 81.6 ± 6.2 years and 1147 (60.2%) patients were female; mean CHADS2 and CHA2DS2-VASc scores were 2.2 ± 0.8 and 4.4 ± 1.1, respectively. Fifty-four (2.8%) patients had a stroke within 30 days. At multivariable logistic regression analysis, CHA2DS2-VASc (OR: 1.35, 95% CI: 1.03-1.78; P = 0.031) and previous cardiac surgery (OR: 1.96, 95% CI: 1.06-3.6; P = 0.033) but not CHADS2 (OR: 1.05, 95% CI: 0.76-1.44; P = 0.77) were found to be independent predictors of in-hospital stroke. A CHA2DS2-VASc score ≥5 was strongly related to the occurrence of in-hospital stroke (OR: 2.51, 95% CI: 1.38-4.57; P= 0.001). However, CHA2DS2-VASc score showed only poor accuracy for in-hospital stroke with a trend for better accuracy when compared with CHADS2 score (area under the curve: 0.61, 95% CI: 0.59-0.63 vs 0.51; 95% CI: 0.49-0.54, respectively, P = 0.092). CONCLUSIONS: In TAVI patients, CHA2DS2-VASc provided a strong correlation for in-hospital stroke but with low accuracy. Dedicated scores to properly tailor procedures and preventive strategies are needed.