TY - BOOK AU - Thourani, Vinod H TI - 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 SN - 0003-4975 PY - 2019/// KW - *Aortic Valve Stenosis/su [Surgery] KW - *Hospital Mortality KW - *Registries KW - *Stroke/ep [Epidemiology] KW - *Transcatheter Aortic Valve Replacement/ae [Adverse Effects] KW - Aged KW - Aged, 80 and over KW - Aortic Valve Stenosis/dg [Diagnostic Imaging] KW - Female KW - Humans KW - Male KW - Predictive Value of Tests KW - Prevalence KW - Reproducibility of Results KW - Risk Assessment KW - Risk Management KW - Societies, Medical KW - Stroke/et [Etiology] KW - Thoracic Surgery KW - Transcatheter Aortic Valve Replacement/mo [Mortality] KW - Transcatheter Aortic Valve Replacement/mt [Methods] KW - United States KW - MedStar Heart & Vascular Institute KW - Journal Article N1 - Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007 N2 - 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 UR - https://dx.doi.org/10.1016/j.athoracsur.2018.11.013 ER -