Predictors of Early Cerebrovascular Events in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

• Published in: Journal of the American College of Cardiology Vol. 68; no. 7; pp. 673 - 684
• Main Authors: Auffret, Vincent, MD, MSc, Regueiro, Ander, MD, Del Trigo, María, MD, Abdul-Jawad Altisent, Omar, MD, Campelo-Parada, Francisco, MD, Chiche, Olivier, MD, Puri, Rishi, MBBS, PhD, Rodés-Cabau, Josep, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 16-08-2016; Elsevier Limited; Elsevier
• Subjects: aortic stenosis; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - surgery; Bioengineering; Cardiac arrhythmia; Cardiology; Cardiovascular; Cardiovascular disease; cerebrovascular events; Confidence intervals; Global Health; Hospitals; Humans; Incidence; Internal Medicine; Life Sciences; Mortality; Patients; predictors; Prognosis; Stroke; Stroke - epidemiology; Stroke - etiology; Studies; Time Factors; transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement; predictors; coronary artery disease; RR; chronic kidney disease; NOAF; TVE/M; risk ratio; TAVR; dual antiplatelet therapy; single antiplatelet therapy; atrial fibrillation; aortic stenosis; new-onset atrial fibrillation; transcatheter valve embolization or migration; CKD; transcatheter valve within a transcatheter valve; DAPT; transcatheter aortic valve implantation; TV-in-TV; peripheral artery disease; AF; CI; CAD; ESV; Medtronic CoreValve; transient ischemic attack; stroke; TIA; MSV; AS; PAD; TF; CVE; SAPT; transfemoral; BPD; Edwards-Sapien valve; transcatheter aortic valve replacement; cerebrovascular events; confidence interval; balloon post-dilation; academic research consortium; coronary-artery-disease; randomized clinical-trial; uk tavi registry; chronic kidney-disease; onset atrial-fibrillation; end-point definitions; expanding corevalve prosthesis
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2016.05.065

Abstract Background Identifying transcatheter aortic valve replacement (TAVR) patients at high risk for cerebrovascular events (CVE) is of major clinical relevance. However, predictors have varied across studies. Objectives The purpose of this study was to analyze the predictors of 30-day CVE post-TAVR. Methods A systematic review of studies that reported the incidence of CVE post-TAVR while providing raw data for predictors of interest was performed. Data on study, patient, and procedural characteristics were extracted. Crude risk ratios (RRs) and 95% confidence intervals for each predictor were calculated. Results Sixty-four studies involving 72,318 patients (2,385 patients with a CVE within 30 days post-TAVR) were analyzed. Incidence of CVE ranged from 1% to 11% (median 4%) without significant differences between single and multicenter studies, or according to CVE adjudication availability. The summary RRs indicated lower risk for men (RR: 0.82; p = 0.02) and higher risk for patients with chronic kidney disease (RR: 1.29; p = 0.03) and with new-onset atrial fibrillation post-TAVR (RR: 1.85; p = 0.005), and for procedures performed within the first half of center experience (RR: 1.55; p = 0.003). The use of balloon post-dilation tended to be associated with a higher risk of CVE (RR: 1.43; p = 0.07). Valve type (balloon-expandable vs. self-expandable, p = 0.26) and approach (transfemoral vs. nontransfemoral, p = 0.81) did not predict CVE. Conclusions Female sex, chronic kidney disease, enrollment date, and new-onset atrial fibrillation were predictors of CVE post-TAVR. This study provides effect estimates to identify high-risk TAVR patients for early CVE, providing possible guidance for tailored preventive strategies.