TY - JOUR
T1 - Clinical Predictors for Procedural Stroke and Implications for Embolic Protection Devices during TAVR
T2 - Results from the Multicenter Transcatheter Aortic Valve Replacement In-Hospital Stroke (TASK) Study
AU - Berkovitch, Anat
AU - Segev, Amit
AU - Maor, Elad
AU - Sedaghat, Alexander
AU - Finkelstein, Ariel
AU - Saccocci, Matteo
AU - Kornowski, Ran
AU - Latib, Azeem
AU - Hernandez, Jose M.De La Torre
AU - Søndergaard, Lars
AU - Mylotte, Darren
AU - Royen, Niels Van
AU - Zaman, Azfar G.
AU - Robert, Pierre
AU - Sinning, Jan Malte
AU - Steinvil, Arie
AU - Maisano, Francesco
AU - Orvin, Katia
AU - Iannopollo, Gianmarco
AU - Lee, Dae Hyun
AU - Backer, Ole De
AU - Mercanti, Federico
AU - van der Wulp, Kees
AU - Shome, Joy
AU - Tchétché, Didier
AU - Barbash, Israel M.
N1 - Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2022/7
Y1 - 2022/7
N2 - Background: Data to support the routine use of embolic protection devices for stroke prevention during transcatheter aortic valve replacement (TAVR) are controversial. Identifying patients at high risk for peri-procedural cerebrovascular events may facilitate effective patient selection for embolic protection devices during TAVR. Aim: To generate a risk score model for stratifying TAVR patients according to peri-procedural cerebrovascular events risk. Methods and results: A total of 8779 TAVR patients from 12 centers worldwide were included. Peri-procedural cerebrovascular events were defined as an ischemic stroke or a transient ischemic attack occurring ≤24 h from TAVR. The peri-procedural cerebrovascular events rate was 1.4% (n = 127), which was independently associated with 1-year mortality (hazards ratio (HR) 1.78, 95% confidence interval (CI) 1.06–2.98, p < 0.028). The TASK risk score parameters were history of stroke, use of a non-balloon expandable valve, chronic kidney disease, and peripheral vascular disease, and each parameter was assigned one point. Each one-point increment was associated with a significant increase in peri-procedural cerebrovascular events risk (OR 1.96, 95% CI 1.56–2.45, p < 0.001). The TASK score was dichotomized into very-low, low, intermediate, and high (0, 1, 2, 3–4 points, respectively). The high-risk TASK score group (OR 5.4, 95% CI 2.06–14.16, p = 0.001) was associated with a significantly higher risk of peri-procedural cerebrovascular events compared with the low TASK score group. Conclusions: The proposed novel TASK risk score may assist in the pre-procedural risk stratification of TAVR patients for peri-procedural cerebrovascular events.
AB - Background: Data to support the routine use of embolic protection devices for stroke prevention during transcatheter aortic valve replacement (TAVR) are controversial. Identifying patients at high risk for peri-procedural cerebrovascular events may facilitate effective patient selection for embolic protection devices during TAVR. Aim: To generate a risk score model for stratifying TAVR patients according to peri-procedural cerebrovascular events risk. Methods and results: A total of 8779 TAVR patients from 12 centers worldwide were included. Peri-procedural cerebrovascular events were defined as an ischemic stroke or a transient ischemic attack occurring ≤24 h from TAVR. The peri-procedural cerebrovascular events rate was 1.4% (n = 127), which was independently associated with 1-year mortality (hazards ratio (HR) 1.78, 95% confidence interval (CI) 1.06–2.98, p < 0.028). The TASK risk score parameters were history of stroke, use of a non-balloon expandable valve, chronic kidney disease, and peripheral vascular disease, and each parameter was assigned one point. Each one-point increment was associated with a significant increase in peri-procedural cerebrovascular events risk (OR 1.96, 95% CI 1.56–2.45, p < 0.001). The TASK score was dichotomized into very-low, low, intermediate, and high (0, 1, 2, 3–4 points, respectively). The high-risk TASK score group (OR 5.4, 95% CI 2.06–14.16, p = 0.001) was associated with a significantly higher risk of peri-procedural cerebrovascular events compared with the low TASK score group. Conclusions: The proposed novel TASK risk score may assist in the pre-procedural risk stratification of TAVR patients for peri-procedural cerebrovascular events.
KW - aortic stenosis
KW - stroke
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85133440174&partnerID=8YFLogxK
U2 - 10.3390/jpm12071056
DO - 10.3390/jpm12071056
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 35887554
AN - SCOPUS:85133440174
SN - 2075-4426
VL - 12
JO - Journal of Personalized Medicine
JF - Journal of Personalized Medicine
IS - 7
M1 - 1056
ER -