MedStar Authors catalog › Details for: Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement - A Report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement - A Report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
Citation: Annals of Thoracic Surgery. 107(4):1097-1103, 2019 04.; .Journal: European journal of emergency medicine : official journal of the European Society for Emergency Medicine.Published: 2019; ; ; ISSN: 0003-4975.Full author list: Arnold SV; Bavaria JE; Brennan JM; Carroll EJ; Cohen DJ; Edwards FH; Fitzgerald S; Forcillo J; Grover FL; Holmes DR; Kelly JJ; Mack MJ; O'Brien SM; Peterson ED; Shahian DM; Thourani VH; Vemulapalli S.UI/PMID: 30529671.Subject(s): *Aortic Valve Stenosis/su [Surgery] | *Hospital Mortality | *Registries | *Stroke/ep [Epidemiology] | *Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Aged | Aged, 80 and over | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Female | Humans | Male | Predictive Value of Tests | Prevalence | Reproducibility of Results | Risk Assessment | Risk Management | Societies, Medical | Stroke/et [Etiology] | Thoracic Surgery | Transcatheter Aortic Valve Replacement/mo [Mortality] | Transcatheter Aortic Valve Replacement/mt [Methods] | United StatesInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1016/j.athoracsur.2018.11.013 (Click here)Abbreviated citation: Ann Thorac Surg. 107(4):1097-1103, 2019 04; .Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: Stroke is a serious complication following transcatheter aortic valve replacement (TAVR), yet predictive models are not available. A new risk model for in-hospital stroke following TAVR was developed and used to estimate site-specific performance.Abstract: CONCLUSIONS: A risk model for in-hospital stroke following TAVR was developed from the STS/ACC TVT Registry and used to estimate site-specific stroke performance. This model can serve as a valuable resource for quality improvement, clinical decision-making, and patient counseling.Abstract: Copyright (c) 2018. Published by Elsevier Inc.Abstract: METHODS: We included 97,600 TAVR procedures from 521 sites in the STS/ACC Transcatheter Valve Therapy (TVT) Registry from July 2014 through June 2017. Association between baseline covariates and in-hospital stroke was estimated by logistic regression. Discrimination was evaluated by C statistic. Calibration was tested internally via cross validation. Hierarchical modeling was used to estimate risk-adjusted site-specific performance.Abstract: RESULTS: Median age was 82 years, 44,926 (46.0%) were female, and 1,839 (1.9%) had in-hospital stroke. Covariates associated with stroke (odds ratio) included transapical access (1.44), access excluding transapical and transfemoral (1.77), prior stroke (1.57), prior TIA (1.50), pre-procedural shock, inotropes or mechanical assist device (1.48), smoking (1.28), porcelain aorta (1.23), peripheral arterial disease (1.21), age per 5 years (1.11), glomerular filtration rate per 5 ml/min (0.97), body surface area per m<sup>2</sup> (0.55 male; 0.43 female), and prior aortic valve (0.78) and non-aortic valvular (0.42) procedures. The C statistic was 0.622. Calibration curves demonstrated agreement between observed and expected stroke rates. Hierarchical modeling showed 10 centers (1.9%) with significantly higher odds ratios for in-hospital stroke than their peers.