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).
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
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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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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