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Stroke rate after TAVR stable between 2011 and 2017
In analysis of more than 100,000 patients from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry who underwent transcatheter aortic valve replacement between 2011 and 2017, 30-day stroke rates after the procedure were consistent over time.
The researchers conducted a retrospective cohort study of 101,430 patients (median age, 83 years; 47% women; 83.9% with transfemoral access) who had TAVR at 521 U.S. hospitals between Nov. 9, 2011, and May 31, 2017.
The primary outcome was stroke and transient ischemic attack at 30 days. The researchers also analyzed the relationship between stroke and 30-day mortality and the relationship between antithrombotic medical therapies and 30-day stroke after discharge.
At 30 days, stroke was observed in 2.3% of patients (95% CI, 2.2-2.4) and TIA was observed in 0.4% of patients (95% CI, 0.3-0.4), Chetan P. Huded, MD, MSc, fellow in cardiovascular medicine at Cleveland Clinic, and colleagues wrote.
The rate of 30-day stroke remained stable across the study period in the overall cohort (P for trend = .22) and the transfemoral-access cohort (P for trend = .47), according to the researchers.
Among those who had stroke, 48.9% of incidents occurred within the first day and 68.4% occurred within the first 3 days, the researchers wrote.
The 30-day mortality rate was 16.7% in patients who had a stroke vs. 3.7% in patients who did not (risk-adjusted HR = 6.1; 95% CI, 5.4-6.8), Huded and colleagues found.
In a propensity-score matched analysis, there was no relationship between treatment with dual antiplatelet therapy and 30-day stroke risk in the femoral-access cohort (HR = 1.04; 95% CI, 0.74-1.46) or in the nonfemoral-access cohort (HR = 1.02; 95% CI, 0.54-1.95), nor was there a relationship between treatment with oral anticoagulation and 30-day stroke risk in the femoral-access cohort (HR = 1.03; 95% CI, 0.73-1.46) or in the nonfemoral-access cohort (HR = 0.93; 95% CI, 0.47-1.83).
“These findings offer insight into population trends in the safety of TAVR in the United States as a framework for future efforts to reduce post-TAVR stroke rates,” Huded and colleagues wrote.
In a related editorial, Steven R. Messé, MD, associate professor of neurology and director of the vascular neurology fellowship at the Hospital of the University of Pennsylvania, and Gorav Ailawadi, MD, professor of surgery and section chief of adult cardiac surgery at the University of Virginia, wrote that the study “provides important insight into stroke complicating TAVR in clinical practice, although it is likely that stroke events were underestimated. There is more work to be done on neurologic outcomes following TAVR.” – by Erik Swain
Disclosures: Huded reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures. Ailawadi reports he received personal fees from Abbott, Admedus, Edwards Lifesciences and Medtronic. Messé reports he received consultant and personal fees from Claret Medical, personal fees from the Yale Cardiovascular Research Group and grant support from W.L. Gore and Associates.