Insights Into Timing, Risk Factors, and Outcomes of Stroke and Transient Ischemic Attack After Transcatheter Aortic Valve Replacement in the PARTNER Trial (Placement of Aortic Transcatheter Valves).

MedStar author(s):
Citation: Circulation: Cardiovascular Interventions. 9(9), 2016 SepPMID: 27601428Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Insufficiency/su [Surgery] | *Aortic Valve Stenosis/su [Surgery] | *Ischemic Attack, Transient/ep [Epidemiology] | *Stroke/ep [Epidemiology] | *Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Aged | Aged, 80 and over | Aortic Valve Insufficiency/dg [Diagnostic Imaging] | Aortic Valve Insufficiency/mo [Mortality] | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | Cardiac Catheterization | Female | Femoral Artery | Humans | Incidence | Ischemic Attack, Transient/di [Diagnosis] | Ischemic Attack, Transient/mo [Mortality] | Ischemic Attack, Transient/th [Therapy] | Kaplan-Meier Estimate | Male | Punctures | Registries | Risk Assessment | Risk Factors | Stroke/di [Diagnosis] | Stroke/mo [Mortality] | Stroke/th [Therapy] | Time Factors | Transcatheter Aortic Valve Replacement/mo [Mortality] | Transcatheter Aortic Valve Replacement/mt [Methods] | Treatment OutcomeYear: 2016Local holdings: Available online from MWHC library: 2008 - presentISSN:
  • 1941-7640
Abstract: BACKGROUND: Prior studies of stroke and transient ischemic attack (TIA) after transcatheter aortic valve replacement (TAVR) are limited by reporting and follow-up variability. This is a comprehensive analysis of time-related incidence, risk factors, and outcomes of these events.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.CONCLUSIONS: Risk of stroke or TIA is highest early after TAVR and is associated with increased 1-year mortality. Modifications of TAVR, emboli-prevention devices, and better intraprocedural pharmacological protection may mitigate this risk.Copyright � 2016 American Heart Association, Inc.METHODS AND RESULTS: From April 2007 to February 2012, 2621 patients, aged 84+/-7.2 years, underwent transfemoral (TF; 1521) or transapical (TA; 1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves; as-treated), including the continued access registry. Stroke and TIA were identified by protocol and adjudicated by a Clinical Events Committee. Within 30 days of TAVR, 87 (3.3%) patients experienced a stroke (TF 58 [3.8%]; TA 29 [2.7%]; P=0.09), 85% within 1 week. Instantaneous stroke risk peaked on day 2, then fell to a low prolonged risk of 0.8% by 1 to 2 weeks. Within 30 days, 13 (0.50%) patients experienced a TIA (TF 10 [0.67%]; TA 3 [0.27%]; P>0.17). Stroke and TIA were associated with lower 1-year survival than expected (TF 47% after stroke versus 82%, and 64% after TIA versus 83%; TA 53% after stroke versus 80%, and 64% after TIA versus 83%). Risk factors for early stroke after TA-TAVR included more postdilatations, pure aortic stenosis without regurgitation, and possibly more pacing runs, earlier date of procedure, and no dual antiplatelet therapy; high pre-TAVR aortic peak gradient was a risk factor for stroke early after TF-TAVR.All authors: Agarwal S, Blackstone EH, Ehrlinger J, Ellis S, Herrmann HC, Kapadia S, Kodali S, Leon MB, Mack M, Makkar R, Miller DC, Pichard AD, Rajeswaran J, Smith CR, Svensson LG, Thourani VH, Tuzcu EM, Webb JGFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-24
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 27601428 Available 27601428

Available online from MWHC library: 2008 - present

BACKGROUND: Prior studies of stroke and transient ischemic attack (TIA) after transcatheter aortic valve replacement (TAVR) are limited by reporting and follow-up variability. This is a comprehensive analysis of time-related incidence, risk factors, and outcomes of these events.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.

CONCLUSIONS: Risk of stroke or TIA is highest early after TAVR and is associated with increased 1-year mortality. Modifications of TAVR, emboli-prevention devices, and better intraprocedural pharmacological protection may mitigate this risk.

Copyright � 2016 American Heart Association, Inc.

METHODS AND RESULTS: From April 2007 to February 2012, 2621 patients, aged 84+/-7.2 years, underwent transfemoral (TF; 1521) or transapical (TA; 1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves; as-treated), including the continued access registry. Stroke and TIA were identified by protocol and adjudicated by a Clinical Events Committee. Within 30 days of TAVR, 87 (3.3%) patients experienced a stroke (TF 58 [3.8%]; TA 29 [2.7%]; P=0.09), 85% within 1 week. Instantaneous stroke risk peaked on day 2, then fell to a low prolonged risk of 0.8% by 1 to 2 weeks. Within 30 days, 13 (0.50%) patients experienced a TIA (TF 10 [0.67%]; TA 3 [0.27%]; P>0.17). Stroke and TIA were associated with lower 1-year survival than expected (TF 47% after stroke versus 82%, and 64% after TIA versus 83%; TA 53% after stroke versus 80%, and 64% after TIA versus 83%). Risk factors for early stroke after TA-TAVR included more postdilatations, pure aortic stenosis without regurgitation, and possibly more pacing runs, earlier date of procedure, and no dual antiplatelet therapy; high pre-TAVR aortic peak gradient was a risk factor for stroke early after TF-TAVR.

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