Wieneke Vlastra1,2, Pilar Jimenez-Quevedo3, Didier Tchétché4, Jaya Chandrasekhar1,2,5, Fabio S de Brito6, Marco Barbanti7, Ran Kornowski8, Azeem Latib9, Augusto D'Onofrio10, Flavio Ribichini11, Jan Baan1,2, Jan G P Tijssen1,2, Jose M De la Torre Hernandez12, Nicolas Dumonteil4, Rogério Sarmento-Leite13, Samantha Sartori5, S Rosato14, Giuseppe Tarantini10, Mattia Lunardi11, Katia Orvin8, Matteo Pagnesi9, Rosana Hernandez-Antolin15, Thomas Modine16, George Dangas5, Roxana Mehran5, Jan J Piek1,2, Ronak Delewi1,2. 1. Heart Center, Amsterdam, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.). 2. Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (W.V., J.C., J.B., J.G.P.T., J.J.P., R.D.). 3. Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain (P.J.-Q.). 4. Clinique Pasteur, Toulouse, France (D.T., N.D.). 5. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C., S.S., G.D., R.M.). 6. Heart Institute (InCor), University of São Paulo Medical School, Brazil (F.S.d.B.). 7. Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Italy (M.B.). 8. Cardiology Department, Rabin Medical Center, Petach Tikva, Israel (R.K., K.O.). 9. Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.L., M.P.). 10. Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (A.D., G.T.). 11. Division of Cardiology, Department of Medicine, University of Verona, Italy (F.R., M.L.). 12. Hospital Marqués de Valdecilla, Servicio de Cardiología, Santander, Cantabria, Spain (J.M.D.l.T.H.). 13. Instituto de Cardiologia do Rio Grando do Sul, Brazil (R.S.-L.). 14. National Centre for Global Helath, Istituto Superiore di Sanità, Rome, Italy (S.R.). 15. Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain (R.H.-A.). 16. Centre Hospitalier Universitaire, Lille, France (T.M.).
Abstract
BACKGROUND: Stroke remains one of the most devastating complications of transcatheter aortic valve implantation (TAVI). The aim of this study was to identify the incidence, timing, temporal trends, and predictors of stroke after TAVI and evaluate the outcomes of patients with stroke. METHODS AND RESULTS: The CENTER-Collaboration is an international collaboration consisting of 3 national registries and 7 local registries or prospective clinical trials, selected through a systematic review. Accordingly, a total of 10 982 patients undergoing transfemoral TAVI between 2007 and 2018 were included in the current patient-level pooled analyses. A total of 261 patients (2.4%) experienced stroke during the first month after TAVI. The median time between TAVI and stroke was 1 day (interquartile range, 0-6 days). The stroke rate was comparable in procedures performed in the early years of TAVI (2007-2012) to those in the more recent years of TAVI (2013-2018; both 2.4%; P=1.0). Independent predictors of stroke at 30 days were a history of cerebrovascular events (odds ratio, 2.2; 95% CI, 1.4-3.6; P=0.0012) and a glomerular filtration rate of <30 mL/min per 1.73 m2 (odds ratio, 1.7; 95% CI, 1.0-2.8; P=0.05). Stroke occurring within the first 30 days after TAVI was associated with a 6-fold increase of 30-day mortality (odds ratio, 6.0; 95% CI, 4.4-8.1; P<0.001). Moreover, patients with stroke more frequently had documented new-onset atrial fibrillation (16% versus 3%; P<0.001) and major or life-threatening bleedings (12% versus 7%; P=0.002) at 30-day follow-up. CONCLUSIONS: In this large, global, patient-level analysis, the incidence of stroke after transfemoral TAVI was 2.4%. Prior cerebrovascular events and a low glomerular filtration rate independently predicted the occurrence of stroke after TAVI. The occurrence of stroke after TAVI was associated with a strikingly 6-fold increase of 30-day mortality; additionally, there was a 5-fold higher rate of new-onset atrial fibrillation in patients with stroke. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03588247.
BACKGROUND:Stroke remains one of the most devastating complications of transcatheter aortic valve implantation (TAVI). The aim of this study was to identify the incidence, timing, temporal trends, and predictors of stroke after TAVI and evaluate the outcomes of patients with stroke. METHODS AND RESULTS: The CENTER-Collaboration is an international collaboration consisting of 3 national registries and 7 local registries or prospective clinical trials, selected through a systematic review. Accordingly, a total of 10 982 patients undergoing transfemoral TAVI between 2007 and 2018 were included in the current patient-level pooled analyses. A total of 261 patients (2.4%) experienced stroke during the first month after TAVI. The median time between TAVI and stroke was 1 day (interquartile range, 0-6 days). The stroke rate was comparable in procedures performed in the early years of TAVI (2007-2012) to those in the more recent years of TAVI (2013-2018; both 2.4%; P=1.0). Independent predictors of stroke at 30 days were a history of cerebrovascular events (odds ratio, 2.2; 95% CI, 1.4-3.6; P=0.0012) and a glomerular filtration rate of <30 mL/min per 1.73 m2 (odds ratio, 1.7; 95% CI, 1.0-2.8; P=0.05). Stroke occurring within the first 30 days after TAVI was associated with a 6-fold increase of 30-day mortality (odds ratio, 6.0; 95% CI, 4.4-8.1; P<0.001). Moreover, patients with stroke more frequently had documented new-onset atrial fibrillation (16% versus 3%; P<0.001) and major or life-threatening bleedings (12% versus 7%; P=0.002) at 30-day follow-up. CONCLUSIONS: In this large, global, patient-level analysis, the incidence of stroke after transfemoral TAVI was 2.4%. Prior cerebrovascular events and a low glomerular filtration rate independently predicted the occurrence of stroke after TAVI. The occurrence of stroke after TAVI was associated with a strikingly 6-fold increase of 30-day mortality; additionally, there was a 5-fold higher rate of new-onset atrial fibrillation in patients with stroke. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03588247.
Authors: Stephan Haussig; Constantin Pleissner; Norman Mangner; Felix Woitek; Marion Zimmer; Philipp Kiefer; Florian Schlotter; Georg Stachel; Sergey Leontyev; David Holzhey; Michael A Borger; Axel Linke Journal: CJC Open Date: 2021-02-01
Authors: Mauro Chiarito; Alessandro Spirito; Johny Nicolas; Alexandra Selberg; Giulio Stefanini; Antonio Colombo; Bernhard Reimers; Annapoorna Kini; Samin K Sharma; George D Dangas; Roxana Mehran Journal: J Clin Med Date: 2022-07-30 Impact factor: 4.964
Authors: Wieneke Vlastra; Thomas P W van den Boogert; Thomas Krommenhoek; Anne-Sophie G T Bronzwaer; Henk J M M Mutsaerts; Hakim C Achterberg; Esther E Bron; Wiro J Niessen; Charles B L M Majoie; Aart J Nederveen; Jan Baan; Johannes J van Lieshout; Jan J Piek; R Nils Planken; José P S Henriques; Ronak Delewi Journal: Int J Cardiovasc Imaging Date: 2019-07-16 Impact factor: 2.357