Aung Myat1,2, Luke Buckner2, Florence Mouy2, James Cockburn1, Andreas Baumbach3,4,5, Adrian P Banning6, Daniel J Blackman7, Nick Curzen8, Philip MacCarthy9, Michael Mullen4, Mark de Belder4,10, Ian Cox11, Jan Kovac12, Stephen Brecker13, Mark Turner14, Saib Khogali15, Iqbal S Malik16, Osama Alsanjari1, Simon Redwood17, Bernard Prendergast17, Uday Trivedi1, Derek Robinson18, Peter Ludman19, Adam de Belder1, David Hildick-Smith1. 1. Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. 2. Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK. 3. William Harvey Research Institute, Queen Mary University of London, London, UK. 4. Barts Heart Center, Barts Health NHS Trust, London, UK. 5. Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. 6. Oxford Heart Center, Oxford University Hospitals NHS Trust, Oxford, UK. 7. Yorkshire Heart Center, The Leeds Teaching Hospitals NHS Trust, Leeds, UK. 8. Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 9. Faculty of Life Sciences and Medicine, King's College London and King's College Hospital NHS Foundation Trust, London, UK. 10. Cardiology Department, The James Cook University Hospital, Middlesbrough, UK. 11. Department of Cardiology, University Hospitals Plymouth NHS Trust, Plymouth, UK. 12. Glenfield Hospital, University of Leicester, Leicester, UK. 13. Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, UK. 14. Bristol Heart Institute, University Hospital Bristol NHS Foundation Trust, Bristol, UK. 15. Heart and Lung Center, New Cross Hospital, Wolverhampton, UK. 16. Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK. 17. Cardiothoracic Directorate, Guy's and St. Thomas' NHS Foundation Trust, London, UK. 18. Department of Mathematics, University of Sussex, Brighton, UK. 19. Cardiology Department, Queen Elizabeth Hospital, Birmingham, UK.
Abstract
OBJECTIVES: We sought to identify baseline demographics and procedural factors that might independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI). BACKGROUND: Stroke is a recognized, albeit infrequent, complication of TAVI. Established predictors of procedure-related in-hospital stroke; however, remain poorly defined. METHODS: We conducted an observational cohort analysis of the multicenter UK TAVI registry. The primary outcome measure was the incidence of in-hospital stroke. RESULTS: A total of 8,652 TAVI procedures were performed from 2007 to 2015. There were 205 in-hospital strokes reported by participating centers equivalent to an overall stroke incidence of 2.4%. Univariate analysis showed that the implantation of balloon-expandable valves caused significantly fewer strokes (balloon-expandable 96/4,613 [2.08%] vs. self-expandable 95/3,272 [2.90%]; p = .020). After multivariable analysis, prior cerebrovascular disease (CVD) (odds ratio [OR] 1.51, 95% confidence interval [CI 1.05-2.17]; p = .03), advanced age at time of operation (OR 1.02 [0.10-1.04]; p = .05), bailout coronary stenting (OR 5.94 [2.03-17.39]; p = .008), and earlier year of procedure (OR 0.93 [0.87-1.00]; p = .04) were associated with an increased in-hospital stroke risk. There was a reduced stroke risk in those who had prior cardiac surgery (OR 0.62 [0.41-0.93]; p = .01) and a first-generation balloon-expandable valve implanted (OR 0.72 [0.53-0.97]; p = .03). In-hospital stroke significantly increased 30-day (OR 5.22 [3.49-7.81]; p < .001) and 1-year mortality (OR 3.21 [2.15-4.78]; p < .001). CONCLUSIONS: In-hospital stroke after TAVI is associated with substantially increased early and late mortality. Factors independently associated with in-hospital stroke were previous CVD, advanced age, no prior cardiac surgery, and deployment of a predominantly first-generation self-expandable transcatheter heart valve.
OBJECTIVES: We sought to identify baseline demographics and procedural factors that might independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI). BACKGROUND:Stroke is a recognized, albeit infrequent, complication of TAVI. Established predictors of procedure-related in-hospital stroke; however, remain poorly defined. METHODS: We conducted an observational cohort analysis of the multicenter UK TAVI registry. The primary outcome measure was the incidence of in-hospital stroke. RESULTS: A total of 8,652 TAVI procedures were performed from 2007 to 2015. There were 205 in-hospital strokes reported by participating centers equivalent to an overall stroke incidence of 2.4%. Univariate analysis showed that the implantation of balloon-expandable valves caused significantly fewer strokes (balloon-expandable 96/4,613 [2.08%] vs. self-expandable 95/3,272 [2.90%]; p = .020). After multivariable analysis, prior cerebrovascular disease (CVD) (odds ratio [OR] 1.51, 95% confidence interval [CI 1.05-2.17]; p = .03), advanced age at time of operation (OR 1.02 [0.10-1.04]; p = .05), bailout coronary stenting (OR 5.94 [2.03-17.39]; p = .008), and earlier year of procedure (OR 0.93 [0.87-1.00]; p = .04) were associated with an increased in-hospital stroke risk. There was a reduced stroke risk in those who had prior cardiac surgery (OR 0.62 [0.41-0.93]; p = .01) and a first-generation balloon-expandable valve implanted (OR 0.72 [0.53-0.97]; p = .03). In-hospital stroke significantly increased 30-day (OR 5.22 [3.49-7.81]; p < .001) and 1-year mortality (OR 3.21 [2.15-4.78]; p < .001). CONCLUSIONS: In-hospital stroke after TAVI is associated with substantially increased early and late mortality. Factors independently associated with in-hospital stroke were previous CVD, advanced age, no prior cardiac surgery, and deployment of a predominantly first-generation self-expandable transcatheter heart valve.