Purpose: Stroke occurrence in patients undergoing transcatheter aortic valve implantation (TAVI) has been reported among complications in several studies. The aim of this study was to assess the impact of periprocedural stroke on mortality at mid-term follow-up after TAVI. Methods: Six-hundred-fifty-six patients with aortic stenosis underwent TAVI with the CoreValve system (92.8%) or the Edwards SAPIEN valve system (7.2%). Stroke and transient ischemic attack were defined according to the Valve Academic Research Consortium-2 consensus document. A cerebrovascular accident (CVA) was defined as any stroke or transient ischemic attack. Periprocedural stroke or CVA were defined as stroke or CVA occurring within 72 hours from the index procedure. Separate multivariable Cox regression analyses were performed to calculate hazard ratio (HR) with 95% confidence intervals (CI) of mortality for periprocedural stroke and periprocedural CVA, respectively. Results: Procedural success occurred in 97.4% of patients. The incidence of any stroke and of CVA after the index procedure was 2.4% and 2.7%, respectively. Periprocedural strokes accounted for 56.2% of all strokes and occurred in 1.4% of patients included in the study. Periprocedural CVA accounted for 55.6% of all CVA and occurred in 1.5% of patients. After a median follow-up of 434 days, all-cause mortality was significantly higher in patients with periprocedural stroke as compared to those without (66.7% vs 22.9%, logrank p=0.001), and in patients with periprocedural CVA as compared to those without (70.0% vs 22.8%, logrank p<0.001). At multivariable Cox regression, periprocedural stroke (HR 4.66, 95% CI 1.95-11.1, p=0.001) and periprocedural CVA (HR 4.64, 95% CI 2.06-10.5, p<0.001) were significant predictors of all-cause mortality. Conclusions: More than half of strokes and CVA following TAVI occur within the periprocedural period. Periprocedural stroke and CVA are independent predictors of all-cause mortality at mid-term follow-up. Strategies for periprocedural cerebrovascular events prevention are needed.
|Titolo:||Impact of periprocedural stroke on mid-term mortality after transcatheter aortic valve implantation|
|Anno del prodotto:||2014|
|Appare nelle tipologie:||4.2 Abstract in Atti di convegno|