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. - 2019

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

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. 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. Copyright (c) 2018. Published by Elsevier Inc. 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. 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 m2 (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.


English

0003-4975

10.1016/j.athoracsur.2018.11.013 [doi] S0003-4975(18)31795-8 [pii]


*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 States


MedStar Heart & Vascular Institute


Journal Article