MedStar Authors catalog › Details for: 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).
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). Published: 2016 ISSN: 1941-7640. UI/PMID: 27601428. Subject(s): Aged | Aged, 80 and over | Aortic Valve Insufficiency/dg [Diagnostic Imaging] | Aortic Valve Insufficiency/mo [Mortality] | *Aortic Valve Insufficiency/su [Surgery] | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | *Aortic Valve Stenosis/su [Surgery] | Cardiac Catheterization | Female | Femoral Artery | Humans | Incidence | Ischemic Attack, Transient/di [Diagnosis] | *Ischemic Attack, Transient/ep [Epidemiology] | Ischemic Attack, Transient/mo [Mortality] | Ischemic Attack, Transient/th [Therapy] | Kaplan-Meier Estimate | Male | Punctures | Registries | Risk Assessment | Risk Factors | Stroke/di [Diagnosis] | *Stroke/ep [Epidemiology] | Stroke/mo [Mortality] | Stroke/th [Therapy] | Time Factors | *Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Transcatheter Aortic Valve Replacement/mt [Methods] | Transcatheter Aortic Valve Replacement/mo [Mortality] | Treatment Outcome Institution(s): MedStar Heart & Vascular Institute Activity type: Journal Article. Medline article type(s): Journal Article Online resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1161/CIRCINTERVENTIONS.115.002981 (Click here) Abbreviated citation: Circ., Cardiovasc. interv.. 9(9), 2016 Sep. Local Holdings: Available online from MWHC library: 2008 - present. 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. Abstract: 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. Abstract: 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. Abstract: CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
Abstract: Copyright � 2016 American Heart Association, Inc.