|
Title
|
|
|
|
The incidence and predictors of early- and mid-term clinically relevant neurological events after transcatheter aortic valve replacement in real-world patients
|
|
|
Author
|
|
|
|
|
|
|
Institution/Organisation
|
|
|
|
ADVANCE Study Investigators
|
|
|
Abstract
|
|
|
|
| BACKGROUND Transcatheter aortic valve replacement (TAVR) enables treatment of high-risk patients with symptomatic aortic stenosis without open-heart surgery; however, the benefits are mitigated by the potential for neurological events. OBJECTIVES This study sought to determine the timing and causes of clinically relevant neurological events after self-expandable TAVR. METHODS We enrolled 1,015 patients, of whom 996 underwent TAVR with a self-expandable system at 44 TAVR-experienced centers in Europe, Colombia, and Israel. Neurological events were evaluated for 3 distinct time periods: periprocedural (0 to 1 days post TAVR); early (2 to 30 days); and late (31 to 730 days). In this real-world study, neurological events were first referred to the site neurologist and then reviewed by an independent neurologist. RESULTS The overall stroke rate was 1.4% through the first day post-procedure, 3.0% at 30 days, and 5.6% at 2 years. There were no significant predictors of periprocedural stroke or stroke/transient ischemic attack (TIA) combined. Significant predictors of early stroke were acute kidney injury (p = 0.03), major vascular complication (p = 0.04), and female sex (p = 0.04). For stroke/TIA combined, prior atrial fibrillation (p = 0.03) and major vascular complication (p = 0.009) were predictive. Coronary artery bypass graft surgery was the only significant predictor of late stroke (p = 0.007) or late stroke/TIA (p = 0.06). CONCLUSIONS Treatment of high-risk patients with aortic stenosis using a self-expandable system was associated with a low stroke rate at short-and long-term follow-up. Multivariable predictors of clinically relevant neurological events differed on the basis of the timing after TAVR. (C) 2015 by the American College of Cardiology Foundation. |
|
|
|
Language
|
|
|
|
English
|
|
|
Source (journal)
|
|
|
|
Journal of the American College of Cardiology. - New York, N.Y.
|
|
|
Publication
|
|
|
|
New York, N.Y.
:
2015
|
|
|
ISSN
|
|
|
|
0735-1097
|
|
|
DOI
|
|
|
|
10.1016/J.JACC.2015.05.025
|
|
|
Volume/pages
|
|
|
|
66
:3
(2015)
, p. 209-217
|
|
|
ISI
|
|
|
|
000358263700001
|
|
|
Pubmed ID
|
|
|
|
26184612
|
|
|
Full text (Publisher's DOI)
|
|
|
|
|
|
|
Full text (open access)
|
|
|
|
|
|
|
Full text (publisher's version - intranet only)
|
|
|
|
|
|