In-hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis

Aung Myat; Luke Buckner; Florence Mouy; James Cockburn; Andreas Baumbach; Adrian P. Banning; Daniel J. Blackman; Nick Curzen; Philip MacCarthy; Michael Mullen; Mark de Belder; Ian Cox; Jan Kovac; Stephen Brecker; Mark Turner; Saib Khogali; Iqbal S. Malik; Osama Alsanjari; Simon Redwood; Bernard Prendergast; Uday Trivedi; Derek Robinson; Peter Ludman; Adam de Belder; David Hildick-Smith

doi:10.1002/ccd.29157

In-hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis

Aung Myat, Luke Buckner, Florence Mouy, James Cockburn, Andreas Baumbach, Adrian P. Banning, Daniel J. Blackman, Nick Curzen, Philip MacCarthy, Michael Mullen, Mark de Belder, Ian Cox, Jan Kovac, Stephen Brecker, Mark Turner, Saib Khogali, Iqbal S. Malik, Osama Alsanjari, Simon Redwood, Bernard PrendergastUday Trivedi, Derek Robinson, Peter Ludman, Adam de Belder, David Hildick-Smith^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Objectives: We sought to identify baseline demographics and procedural factors that might independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI). Background: Stroke is a recognized, albeit infrequent, complication of TAVI. Established predictors of procedure-related in-hospital stroke; however, remain poorly defined. Methods: We conducted an observational cohort analysis of the multicenter UK TAVI registry. The primary outcome measure was the incidence of in-hospital stroke. Results: A total of 8,652 TAVI procedures were performed from 2007 to 2015. There were 205 in-hospital strokes reported by participating centers equivalent to an overall stroke incidence of 2.4%. Univariate analysis showed that the implantation of balloon-expandable valves caused significantly fewer strokes (balloon-expandable 96/4,613 [2.08%] vs. self-expandable 95/3,272 [2.90%]; p =.020). After multivariable analysis, prior cerebrovascular disease (CVD) (odds ratio [OR] 1.51, 95% confidence interval [CI 1.05–2.17]; p =.03), advanced age at time of operation (OR 1.02 [0.10–1.04]; p =.05), bailout coronary stenting (OR 5.94 [2.03–17.39]; p =.008), and earlier year of procedure (OR 0.93 [0.87–1.00]; p =.04) were associated with an increased in-hospital stroke risk. There was a reduced stroke risk in those who had prior cardiac surgery (OR 0.62 [0.41–0.93]; p =.01) and a first-generation balloon-expandable valve implanted (OR 0.72 [0.53–0.97]; p =.03). In-hospital stroke significantly increased 30-day (OR 5.22 [3.49–7.81]; p <.001) and 1-year mortality (OR 3.21 [2.15–4.78]; p <.001). Conclusions: In-hospital stroke after TAVI is associated with substantially increased early and late mortality. Factors independently associated with in-hospital stroke were previous CVD, advanced age, no prior cardiac surgery, and deployment of a predominantly first-generation self-expandable transcatheter heart valve.

Original language	English
Journal	CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
DOIs	https://doi.org/10.1002/ccd.29157
Publication status	Accepted/In press - 1 Jan 2020

Keywords

aortic stenosis
balloon-expandable heart valve
self-expandable heart valve

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/ccd.29157

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Myat, A., Buckner, L., Mouy, F., Cockburn, J., Baumbach, A., Banning, A. P., Blackman, D. J., Curzen, N., MacCarthy, P., Mullen, M., de Belder, M., Cox, I., Kovac, J., Brecker, S., Turner, M., Khogali, S., Malik, I. S., Alsanjari, O., Redwood, S., ... Hildick-Smith, D. (Accepted/In press). In-hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis. CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. https://doi.org/10.1002/ccd.29157

@article{1b0c6295247d44d7b61e025bd74b9f01,

title = "In-hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis",

abstract = "Objectives: We sought to identify baseline demographics and procedural factors that might independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI). Background: Stroke is a recognized, albeit infrequent, complication of TAVI. Established predictors of procedure-related in-hospital stroke; however, remain poorly defined. Methods: We conducted an observational cohort analysis of the multicenter UK TAVI registry. The primary outcome measure was the incidence of in-hospital stroke. Results: A total of 8,652 TAVI procedures were performed from 2007 to 2015. There were 205 in-hospital strokes reported by participating centers equivalent to an overall stroke incidence of 2.4%. Univariate analysis showed that the implantation of balloon-expandable valves caused significantly fewer strokes (balloon-expandable 96/4,613 [2.08%] vs. self-expandable 95/3,272 [2.90%]; p =.020). After multivariable analysis, prior cerebrovascular disease (CVD) (odds ratio [OR] 1.51, 95% confidence interval [CI 1.05–2.17]; p =.03), advanced age at time of operation (OR 1.02 [0.10–1.04]; p =.05), bailout coronary stenting (OR 5.94 [2.03–17.39]; p =.008), and earlier year of procedure (OR 0.93 [0.87–1.00]; p =.04) were associated with an increased in-hospital stroke risk. There was a reduced stroke risk in those who had prior cardiac surgery (OR 0.62 [0.41–0.93]; p =.01) and a first-generation balloon-expandable valve implanted (OR 0.72 [0.53–0.97]; p =.03). In-hospital stroke significantly increased 30-day (OR 5.22 [3.49–7.81]; p <.001) and 1-year mortality (OR 3.21 [2.15–4.78]; p <.001). Conclusions: In-hospital stroke after TAVI is associated with substantially increased early and late mortality. Factors independently associated with in-hospital stroke were previous CVD, advanced age, no prior cardiac surgery, and deployment of a predominantly first-generation self-expandable transcatheter heart valve.",

keywords = "aortic stenosis, balloon-expandable heart valve, self-expandable heart valve",

author = "Aung Myat and Luke Buckner and Florence Mouy and James Cockburn and Andreas Baumbach and Banning, {Adrian P.} and Blackman, {Daniel J.} and Nick Curzen and Philip MacCarthy and Michael Mullen and {de Belder}, Mark and Ian Cox and Jan Kovac and Stephen Brecker and Mark Turner and Saib Khogali and Malik, {Iqbal S.} and Osama Alsanjari and Simon Redwood and Bernard Prendergast and Uday Trivedi and Derek Robinson and Peter Ludman and {de Belder}, Adam and David Hildick-Smith",

year = "2020",

month = jan,

day = "1",

doi = "10.1002/ccd.29157",

language = "English",

journal = "CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS",

issn = "1522-1946",

publisher = "Wiley-Liss Inc.",

}

Myat, A, Buckner, L, Mouy, F, Cockburn, J, Baumbach, A, Banning, AP, Blackman, DJ, Curzen, N, MacCarthy, P, Mullen, M, de Belder, M, Cox, I, Kovac, J, Brecker, S, Turner, M, Khogali, S, Malik, IS, Alsanjari, O, Redwood, S , Prendergast, B, Trivedi, U, Robinson, D, Ludman, P, de Belder, A & Hildick-Smith, D 2020, 'In-hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis', CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. https://doi.org/10.1002/ccd.29157

TY - JOUR

T1 - In-hospital stroke after transcatheter aortic valve implantation

T2 - A UK observational cohort analysis

AU - Myat, Aung

AU - Buckner, Luke

AU - Mouy, Florence

AU - Cockburn, James

AU - Baumbach, Andreas

AU - Banning, Adrian P.

AU - Blackman, Daniel J.

AU - Curzen, Nick

AU - MacCarthy, Philip

AU - Mullen, Michael

AU - de Belder, Mark

AU - Cox, Ian

AU - Kovac, Jan

AU - Brecker, Stephen

AU - Turner, Mark

AU - Khogali, Saib

AU - Malik, Iqbal S.

AU - Alsanjari, Osama

AU - Redwood, Simon

AU - Prendergast, Bernard

AU - Trivedi, Uday

AU - Robinson, Derek

AU - Ludman, Peter

AU - de Belder, Adam

AU - Hildick-Smith, David

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objectives: We sought to identify baseline demographics and procedural factors that might independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI). Background: Stroke is a recognized, albeit infrequent, complication of TAVI. Established predictors of procedure-related in-hospital stroke; however, remain poorly defined. Methods: We conducted an observational cohort analysis of the multicenter UK TAVI registry. The primary outcome measure was the incidence of in-hospital stroke. Results: A total of 8,652 TAVI procedures were performed from 2007 to 2015. There were 205 in-hospital strokes reported by participating centers equivalent to an overall stroke incidence of 2.4%. Univariate analysis showed that the implantation of balloon-expandable valves caused significantly fewer strokes (balloon-expandable 96/4,613 [2.08%] vs. self-expandable 95/3,272 [2.90%]; p =.020). After multivariable analysis, prior cerebrovascular disease (CVD) (odds ratio [OR] 1.51, 95% confidence interval [CI 1.05–2.17]; p =.03), advanced age at time of operation (OR 1.02 [0.10–1.04]; p =.05), bailout coronary stenting (OR 5.94 [2.03–17.39]; p =.008), and earlier year of procedure (OR 0.93 [0.87–1.00]; p =.04) were associated with an increased in-hospital stroke risk. There was a reduced stroke risk in those who had prior cardiac surgery (OR 0.62 [0.41–0.93]; p =.01) and a first-generation balloon-expandable valve implanted (OR 0.72 [0.53–0.97]; p =.03). In-hospital stroke significantly increased 30-day (OR 5.22 [3.49–7.81]; p <.001) and 1-year mortality (OR 3.21 [2.15–4.78]; p <.001). Conclusions: In-hospital stroke after TAVI is associated with substantially increased early and late mortality. Factors independently associated with in-hospital stroke were previous CVD, advanced age, no prior cardiac surgery, and deployment of a predominantly first-generation self-expandable transcatheter heart valve.

AB - Objectives: We sought to identify baseline demographics and procedural factors that might independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI). Background: Stroke is a recognized, albeit infrequent, complication of TAVI. Established predictors of procedure-related in-hospital stroke; however, remain poorly defined. Methods: We conducted an observational cohort analysis of the multicenter UK TAVI registry. The primary outcome measure was the incidence of in-hospital stroke. Results: A total of 8,652 TAVI procedures were performed from 2007 to 2015. There were 205 in-hospital strokes reported by participating centers equivalent to an overall stroke incidence of 2.4%. Univariate analysis showed that the implantation of balloon-expandable valves caused significantly fewer strokes (balloon-expandable 96/4,613 [2.08%] vs. self-expandable 95/3,272 [2.90%]; p =.020). After multivariable analysis, prior cerebrovascular disease (CVD) (odds ratio [OR] 1.51, 95% confidence interval [CI 1.05–2.17]; p =.03), advanced age at time of operation (OR 1.02 [0.10–1.04]; p =.05), bailout coronary stenting (OR 5.94 [2.03–17.39]; p =.008), and earlier year of procedure (OR 0.93 [0.87–1.00]; p =.04) were associated with an increased in-hospital stroke risk. There was a reduced stroke risk in those who had prior cardiac surgery (OR 0.62 [0.41–0.93]; p =.01) and a first-generation balloon-expandable valve implanted (OR 0.72 [0.53–0.97]; p =.03). In-hospital stroke significantly increased 30-day (OR 5.22 [3.49–7.81]; p <.001) and 1-year mortality (OR 3.21 [2.15–4.78]; p <.001). Conclusions: In-hospital stroke after TAVI is associated with substantially increased early and late mortality. Factors independently associated with in-hospital stroke were previous CVD, advanced age, no prior cardiac surgery, and deployment of a predominantly first-generation self-expandable transcatheter heart valve.

KW - aortic stenosis

KW - balloon-expandable heart valve

KW - self-expandable heart valve

UR - http://www.scopus.com/inward/record.url?scp=85089258044&partnerID=8YFLogxK

U2 - 10.1002/ccd.29157

DO - 10.1002/ccd.29157

M3 - Article

AN - SCOPUS:85089258044

SN - 1522-1946

JO - CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS

JF - CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS

ER -

In-hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis

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Keywords

UN SDGs

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