TY - JOUR
T1 - Stroke and Cardiovascular Outcomes in Patients with Carotid Disease Undergoing Transcatheter Aortic Valve Replacement
AU - Kochar, Ajar
AU - Li, Zhuokai
AU - Harrison, J. Kevin
AU - Hughes, G. Chad
AU - Thourani, Vinod H.
AU - Mack, Michael J.
AU - Matsouaka, Roland A.
AU - Cohen, David J.
AU - Peterson, Eric D.
AU - Jones, W. Schuyler
AU - Vemulapalli, Sreekanth
N1 - Funding Information:
Dr Harrison acts as Duke principal investigator for clinical trials sponsored by Abbott/St Jude, Boston Scientific, Edwards, and Medtronic; Dr Mack is the coprincipal investigator for the PARTNER-3 clinical trial (Placement of Aortic Transcatheter Valve Trial), sponsored by Edwards Lifesciences; Dr Cohen received research grant support from Medtronic, Edwards Lifesciences, Boston Scientific, Abbott Vascular, and consulting income from Medtronic, Edwards Lifesciences; Dr Jones received research grants from Agency for Healthcare Research and Quality, AstraZeneca, American Heart Association, Bristol-Myers Squibb, Doris Duke Charitable Foundation, Medtronic, Merck, Patient-Centered Outcomes Research Institute; Honorarium/ other from American College of Physicians, Bayer, Bristol-Myers Squibb, Daiichi Sankyo, Janssen Pharmaceuticals; Dr Vemulapalli received ACC research grant, STS research grant, Boston scientific speakers bureau and research grant, Abbott vascular research grant, Consulting Novella. The other authors report no conflicts.
Funding Information:
The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry is an initiative of the Society of Thoracic Surgeons and the American College of Cardiology Foundation. This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry and the Society of Thoracic Surgeons.
Publisher Copyright:
© 2018 Lippincott Williams and Wilkins. All rights reserved.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background-Stroke is a serious complication of both transcatheter aortic valve replacement (TAVR) and carotid artery disease (CD). The implications of CD in patients undergoing TAVR are unclear. Methods and Results-The Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapies Registry, consisting of data from consecutive US TAVR cases during the years 2013 to 2015, was linked to Medicare claims data to ascertain 30-day and 1-year cumulative incidence rates of stroke and all-cause mortality. We compared 30-day and 1-year stroke and mortality outcomes between patients with no-CD and patients with moderate, severe, and occlusive CD and adjusted for baseline covariates using proportional hazards models. Among 29 143 patients undergoing TAVR across 390 US sites, 22% had CD. Patients with CD had higher rates of prior hypertension, diabetes mellitus, stroke, and myocardial infarction. Observed in-hospital stroke rates were 2.0% among no-CD, 2.5% among moderate CD, 3.0% among severe CD, and 2.6% among occlusive CD. There was no association between the presence of CD and 30-day stroke (adjusted hazard ratio, 1.16; 95% confidence interval, 0.94-1.43) or mortality (adjusted hazard ratio, 1.10; 95% confidence interval, 0.95-1.28). There was no association between CD and 1-year stroke (adjusted hazard ratio, 1.03; 95% confidence interval, 0.86-1.24) or mortality (adjusted hazard ratio, 1.02; 95% confidence interval, 0.93-1.12). Furthermore, there was no significant risk-adjusted association between severity of CD and 30-day or 1-year stroke or mortality. Conclusions-CD is common among TAVR patients, present in 1 of 5. CD was not associated with an increased risk of stroke or mortality at 30 day or 1 year. Post-TAVR stroke seems to be because of mechanisms other than CD.
AB - Background-Stroke is a serious complication of both transcatheter aortic valve replacement (TAVR) and carotid artery disease (CD). The implications of CD in patients undergoing TAVR are unclear. Methods and Results-The Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapies Registry, consisting of data from consecutive US TAVR cases during the years 2013 to 2015, was linked to Medicare claims data to ascertain 30-day and 1-year cumulative incidence rates of stroke and all-cause mortality. We compared 30-day and 1-year stroke and mortality outcomes between patients with no-CD and patients with moderate, severe, and occlusive CD and adjusted for baseline covariates using proportional hazards models. Among 29 143 patients undergoing TAVR across 390 US sites, 22% had CD. Patients with CD had higher rates of prior hypertension, diabetes mellitus, stroke, and myocardial infarction. Observed in-hospital stroke rates were 2.0% among no-CD, 2.5% among moderate CD, 3.0% among severe CD, and 2.6% among occlusive CD. There was no association between the presence of CD and 30-day stroke (adjusted hazard ratio, 1.16; 95% confidence interval, 0.94-1.43) or mortality (adjusted hazard ratio, 1.10; 95% confidence interval, 0.95-1.28). There was no association between CD and 1-year stroke (adjusted hazard ratio, 1.03; 95% confidence interval, 0.86-1.24) or mortality (adjusted hazard ratio, 1.02; 95% confidence interval, 0.93-1.12). Furthermore, there was no significant risk-adjusted association between severity of CD and 30-day or 1-year stroke or mortality. Conclusions-CD is common among TAVR patients, present in 1 of 5. CD was not associated with an increased risk of stroke or mortality at 30 day or 1 year. Post-TAVR stroke seems to be because of mechanisms other than CD.
KW - carotid stenosis
KW - mortality
KW - stroke
KW - transcatheter aortic valve replacement
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U2 - 10.1161/CIRCINTERVENTIONS.117.006322
DO - 10.1161/CIRCINTERVENTIONS.117.006322
M3 - Article
C2 - 29895600
AN - SCOPUS:85053876705
SN - 1941-7640
VL - 11
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 6
M1 - e006322
ER -