Open heart · 2025
Trends and risk factors of stroke and mortality after transcatheter aortic valve implantation in the Netherlands.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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van Putten Simon E, Hegeman Romy R M J J, Timmers Leo, Overduin Daniel C, Nieuwkerk Pythia T, Peper Joyce, Roefs Maaike M, Sonker Uday, Rensing Benno J W M, Swaans Martin J, Klautz Robert J M, Ten Berg Jurrien, Klein Patrick, THI Registration Committee of the Netherlands Heart Registration
Аннотация
BACKGROUND: Stroke after transcatheter aortic valve implantation (TAVI) is an infrequent but serious complication with important impact on morbidity and mortality. Contemporary real-world evidence on the risk factors of early stroke after TAVI is scarce. We aimed to evaluate the incidence, temporal trends and predictors of in-hospital stroke after TAVI and to assess its association with mortality.
METHODS: We conducted a retrospective, observational cohort study using data from the Netherlands Heart Registration of all TAVI procedures performed in the Netherlands between 2013 and 2023. The primary endpoint was the incidence of in-hospital stroke. The secondary endpoints were trends, mortality and risk factors associated with in-hospital stroke and early mortality as identified by logistic regression.
RESULTS: Among 23 593 TAVI procedures, the overall incidence of in-hospital stroke was 2.0% and remained stable after an initial decline. Independent covariates associated with in-hospital stroke included female gender (OR 1.29; 95% CI 1.07 to 1.56), peripheral arterial disease (OR 1.55; 95% CI 1.24 to 1.93), non-transfemoral access (OR 1.54; 95% CI 1.21 to 1.93) and postdilation (OR 1.40; 95% CI 1.10 to 1.76). In-hospital stroke was strongly associated with an increased risk of mortality at 30 days (OR 8.54; 95% CI 6.56 to 11.02), and 1 year (OR 4.38; 95% CI 3.55 to 5.40).
CONCLUSIONS: In-hospital stroke remains an important complication after TAVI with a strong impact on mortality. Identification of high-risk patients and procedural optimisation is essential in optimisation of outcome.
METHODS: We conducted a retrospective, observational cohort study using data from the Netherlands Heart Registration of all TAVI procedures performed in the Netherlands between 2013 and 2023. The primary endpoint was the incidence of in-hospital stroke. The secondary endpoints were trends, mortality and risk factors associated with in-hospital stroke and early mortality as identified by logistic regression.
RESULTS: Among 23 593 TAVI procedures, the overall incidence of in-hospital stroke was 2.0% and remained stable after an initial decline. Independent covariates associated with in-hospital stroke included female gender (OR 1.29; 95% CI 1.07 to 1.56), peripheral arterial disease (OR 1.55; 95% CI 1.24 to 1.93), non-transfemoral access (OR 1.54; 95% CI 1.21 to 1.93) and postdilation (OR 1.40; 95% CI 1.10 to 1.76). In-hospital stroke was strongly associated with an increased risk of mortality at 30 days (OR 8.54; 95% CI 6.56 to 11.02), and 1 year (OR 4.38; 95% CI 3.55 to 5.40).
CONCLUSIONS: In-hospital stroke remains an important complication after TAVI with a strong impact on mortality. Identification of high-risk patients and procedural optimisation is essential in optimisation of outcome.