Elsevier

The American Journal of Cardiology

Volume 157, 15 October 2021, Pages 79-84
The American Journal of Cardiology

Risk of Ischemic Stroke in Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Prior Stroke

https://doi.org/10.1016/j.amjcard.2021.06.049Get rights and content

It has not been well studied whether transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) have lower risk of ischemic stroke (IS) in those with prior history of IS. From the Nationwide Readmission Database from October 2015 to November 2017, TAVI and SAVR above age 50 were identified with the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System codes. Transapical TAVI and SAVR with concomitant bypass, mitral, or tricuspid surgery were excluded. The primary outcome was in-hospital IS. A total of 92,435 TAVI (13,292 with prior stroke) and 68,651 SAVR (5,365 with prior stroke) were identified. In-hospital IS was significantly lower in TAVI compared with SAVR (3.7% vs 8.0%, adjusted odds ratio 0.65, 95% confidence interval 0.47 to 0.89, p <0.01) with prior stroke whereas it was similar between TAVI and SAVR (1.7% vs 2.1%, adjusted odds ratio 0.97, 95% confidence interval 0.78 to 1.19, p = 0.75) in those without prior stroke (P interaction < 0.001). In-hospital mortality, acute kidney injury, and bleeding were lower in TAVI compared with SAVR in patients with and without prior stroke (P interaction > 0.05 for all). This analysis of a national claims database showed that TAVI was associated with a lower risk of in-hospital IS compared with SAVR among patients with prior stroke.

Section snippets

Methods

NRD between 2015 and 2017 (after October 1st for NRD 2015) was used to identify admissions with the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) (Supplemental Table 1). NRD is developed by the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (www.hcup-us.ahrq.gov/nrdoverview.jsp). Briefly, the NRD is the largest publicly available all-payer in-patient readmission database in the United

Results

A total of weighted 92,435 TAVI (14.4% with prior stroke) and 68,651 SAVR (7.8% with prior stroke) were included in the analysis (Figure 1). Demographics of patients’ baseline comorbidities and hospital characteristics are summarized in Table 1.

TAVI resulted in significantly lower risk of in-hospital IS compared with SAVR in those with prior stroke (3.7% vs 8.0%, adjusted OR 0.65, 95% CI 0.47 to 0.89, p <0.001) but was similar between TAVI and SAVR without prior stroke (1.7% vs 2.1%, adjusted

Discussion

The main findings of our analyses are (1) TAVI had a significantly lower risk of in-hospital and short-term IS compared with SAVR among patients with prior IS but was similar among those without prior stroke, (2) the risk of in-hospital mortality, acute kidney injury, and bleeding requiring transfusions were significantly lower in TAVI than SAVR among patients with and without prior IS, (3) hospitalization cost was lower in TAVI as compared to SAVR among those with prior IS, whereas it did not

Disclosures

All authors have no disclosures.

References (29)

  • P D'Errigo et al.

    Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: results from an intermediate risk propensity-matched population of the Italian OBSERVANT study

    Int J Cardiol

    (2013)
  • E Akintoye et al.

    Aortic valve replacement for severe aortic stenosis before and during the era of transcatheter aortic valve implantation

    Am J Cardiol

    (2020)
  • CP Huded et al.

    Association between transcatheter aortic valve replacement and early postprocedural stroke

    JAMA

    (2019)
  • L Nombela-Franco et al.

    Timing, predictive factors, and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation

    Circulation

    (2012)
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