Long-Term Risk of Stroke After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry.

Okuno, Taishi; Alaour, Bashir; Heg, Dierik Hans; Tueller, David; Pilgrim, Thomas; Muller, Olivier; Noble, Stephane; Jeger, Raban; Reuthebuch, Oliver; Toggweiler, Stefan; Ferrari, Enrico; Templin, Christian; Wenaweser, Peter; Nietlispach, Fabian; Taramasso, Maurizio; Huber, Christoph; Roffi, Marco; Windecker, Stephan; Stortecky, Stefan (2023). Long-Term Risk of Stroke After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry. JACC. Cardiovascular Interventions, 16(24), pp. 2986-2996. Elsevier 10.1016/j.jcin.2023.10.021

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BACKGROUND

Stroke after transcatheter aortic valve replacement (TAVR) is associated with considerable morbidity and mortality. Predictors of stroke and the long-term risk after TAVR remain incompletely understood.

OBJECTIVES

The authors sought to investigate the short- and long-term incidence and predictors of stroke after TAVR in the SwissTAVI Registry.

METHODS

Between February 2011 and June 2021, consecutive patients undergoing TAVR were included. Standardized stroke ratios (SSRs) were calculated to compare trends in stroke of TAVR patients with an age- and sex-matched general population in Switzerland derived from the 2019 Global Burden of Disease study.

RESULTS

A total of 11,957 patients (81.8 ± 6.5 years of age, 48.0% female) were included. One-third of the patients (32.3%) had a history of atrial fibrillation, and 11.8% had a history of cerebrovascular accident. The cumulative 30-day incidence rate of stroke was 3.0%, with 69% of stroke events occurring within the first 48 hours after TAVR. The incidence of stroke was 4.3% at 1 year, and 7.8% at 5 years. Compared with an age- and sex-adjusted general population, the risk of stroke was significantly higher in the TAVR population during the first 2 years after TAVR: first year: SSR 7.26 (95% CI: 6.3-8.36) and 6.82 (95% CI: 5.97-7.79) for males and females, respectively; second year: SSR 1.98 (95% CI: 1.47-2.67) and 1.48 (95% CI: 1.09-2.02) for males and females, respectively; but returned to a comparable level to that observed in the matched population thereafter.

CONCLUSIONS

Compared with an age- and sex-matched population, TAVR patients experienced a higher risk of stroke for up to 2 years after the procedure, and a comparable risk thereafter. (SwissTAVI Registry; NCT01368250).

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