Abstract 12568: Impact of Cerebrovascular Events on Mortality Following Transcatheter Valve Implantation for Severe Aortic Stenosis
Introduction: The occurrence of cerebrovascular events (CVE) is a well-known negative prognostic marker in patients with severe aortic stenosis undergoing surgical aortic valve replacement. However the impact of 30-day CVE on immediate and mid-term mortality following TAVI is unknown.
Methods: A total of 1061 patients (age 81±8 yrs) who underwent TAVI from five centers were included. CVE were categorized as transient ischemic attack (TIA), minor (modified rankin scale<2) and major (modified rankin scale≥2) stroke. Procedural complications, peri- and post-operative major adverse events were prospectively recorded, according to VARC definitions. Median follow-up was 12 (3-23) months.
Results: CVE occurred in 54 (5.1%, TIA: 0.8%, minor stroke 1.4% and major stroke 2.8%) patients within 30 days after the TAVI procedure. A total of 92 patients (8.7%) and 309 patients (29.1%) died within 30 days following TAVI and during the follow-up period, respectively. The occurrence of CVE (16.7% vs. 8.2%, P=0.044), stroke (20.0% vs. 8.2%, P=0.012), and major stroke (30% vs. 8.1%, P=0.001) were associated with a higher mortality rate at 30 days. The occurrence of 30-day stroke (33.1% vs. 22.1%, P=0.041) or major stroke (41.6% vs. 22.1%, P=0.003), but not CVE (29.7% vs. 22.2%, P=0.152) were associated with a higher 1-year mortality (figure). Major stroke at 30 days was an independent predictor of mortality at 30 days (OR: 7.43, 95% CI: 2.45-22.53, P=0.001) and at follow-up (HR: 1.75; 95% CI:1.01 to 3.04, P=0.043) after adjusting for other major procedural complications and baseline characteristics.
Conclusions: The impact of CVE on mortality was mainly determined by the severity of the neurologic event, and only events with permanent deficits (major stroke) were associated with a significantly increased risk of early and mid-term mortality. This highlights the importance of understanding the mechanisms associated with CVEs for appropriate preventive measures.
- © 2012 by American Heart Association, Inc.