Cerebrovascular Events in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation: A Pooled Patient‐Level Study-Reference-Cited by-同舟云学术

Cerebrovascular Events in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation: A Pooled Patient‐Level Study

Published:2024-09-03 Issue:17 Volume:13 Page:
ISSN:2047-9980
Container-title:Journal of the American Heart Association
language:en
Short-container-title:JAHA

Author:

van Nieuwkerk Astrid C.¹^ORCID,Aarts Hugo M.¹^ORCID,Hemelrijk Kimberley I.¹^ORCID,Urbano Carrillo Cristobal²^ORCID,Tchétché Didier³,de Brito Fabio S.⁴,Barbanti Marco⁵^ORCID,Kornowski Ran⁶^ORCID,Latib Azeem⁷⁸^ORCID,D'Onofrio Augusto⁹^ORCID,Ribichini Flavio¹⁰^ORCID,García‐Blas Sergio¹¹^ORCID,Dumonteil Nicolas³,Abizaid Alexandre⁴^ORCID,Sartori Samantha¹²^ORCID,D'Errigo Paola¹³^ORCID,Tarantini Giuseppe⁹^ORCID,Lunardi Mattia¹⁰^ORCID,Orvin Katia⁶^ORCID,Pagnesi Matteo¹⁴^ORCID,Navarro Felipe¹⁵^ORCID,Dangas George¹²^ORCID,Mehran Roxana¹²^ORCID,Delewi Ronak¹^ORCID

Affiliation:

1. Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam the Netherlands

2. Hospital Regional Universitario de Málaga Malaga Spain

3. Clinique Pasteur Toulouse France

4. Heart Institute, University of São Paulo Medical School São Paulo Brazil

5. Università degli Studi di Enna “Kore” Enna Italy

6. Cardiology Department Rabin Medical Center Petach Tikva Israel

7. Department of Cardiology Montefiore Medical Center New York NY USA

8. Division of Cardiology, Department of Medicine University of Cape Town Cape Town South Africa

9. Division of Cardiac Surgery University of Padova Padova Italy

10. Division of Cardiology, Department of Medicine University of Verona Verona Italy

11. Clínico Universitario de Valencia Valencia Spain

12. The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY USA

13. National Centre for Global Health—Istituto Superiore di Sanità Rome Italy

14. Department of Medical and Surgical Specialties, Institute of Cardiology, Radiological Sciences and Public Health, ASST Spedali Civili University of Brescia Brescia Italy

15. Fundacion Jimenez Diaz Ute Madrid Spain

Abstract

Background Cerebrovascular events remain one of the most devastating complications of transcatheter aortic valve implantation (TAVI). Data from real‐world contemporary cohorts on longitudinal trends and outcomes remain limited. The aim of this study was to assess incidence, temporal trends, predictors, and outcomes of cerebrovascular events following transfemoral TAVI. Methods and Results The CENTER2 (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon‐Expandable Valves Versus Self‐Expandable Valves 2) study includes patients undergoing TAVI between 2007 and 2022. The database contains pooled patient‐level data from 10 clinical studies. A total of 24 305 patients underwent transfemoral TAVI (mean age 81.5±6.7 years, 56% women, median Society of Thoracic Surgeon Predicted Risk of Mortality 4.9% [3.1%–8.5%]). Of these patients, 2.2% (n=534) experienced stroke in the first 30 days after TAVI, and 40 (0.4%) had a transient ischemic attack. Stroke rates remained stable during the treatment period (2007–2010: 2.1%, 2011–2014: 2.5%, 2015–2018: 2.1%, 2019–2022: 2.1%; P trend =0.28). Moreover, 30‐day cerebrovascular event rates were similar across Society of Thoracic Surgeon Predicted Risk of Mortality risk categories: 2.1% in low‐risk, 2.6% in intermediate‐risk, and 2.5% in high‐risk patients ( P =0.21). Mortality was higher in patients with 30‐day stroke than without at 30 days (20.3% versus 4.7%; odds ratio, 5.1 [95% CI, 4.1–6.5]; P <0.001) and at 1 year (44.1% versus 15.0%; hazard ratio, 3.5 [95% CI, 3.0–4.2]; P <0.001). One‐year mortality rates for stroke did not decline over time (2007–2010: 46.9%, 2011–2014: 46.0%, 2015–2018: 43.0%, 2019–2022: 39.1%; P trend =0.32). At 1 year, 7.0% of patients undergoing TAVI had a stroke. Conclusions In 24 305 patients who underwent transfemoral TAVI, 30‐day cerebrovascular event incidence remained ≈ 2.2% between 2007 and 2022. Thirty‐day stroke rates were similar throughout Society of Thoracic Surgeon Predicted Risk of Mortality risk categories. Mortality rates after stroke remain high. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03588247.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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