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Lifelong risk of stroke after TAVR: Findings from SwissTAVI Registry

07 Feb 2024

Stroke stands as a major contributor to global morbidity and mortality, imposing a substantial burden on patients, societies, and healthcare systems worldwide. Within the realm of transcatheter aortic valve replacement (TAVR), stroke emerges as a recognized adverse event, manifesting at various stages during and after the procedure. Previous studies extensively delved into short-term incidence, trends, and clinical outcomes related to TAVR-associated stroke.

However, as TAVR indications expand to encompass low/intermediate-risk and younger patients, coupled with increased life expectancy post-procedure, the availability of robust data sources, and heightened awareness of late clinical and subclinical bioprosthetic leaflet thrombosis, the focus has shifted towards understanding the prolonged risk of stroke after TAVR and predicting its occurrence.

In a recent article published in JACC: Cardiovascular Interventions, investigators presented comprehensive examination of both short- and long-term stroke risks post-TAVR, offering insights into evolving trends and predictors. The data is sourced from the mandatory prospective national SwissTAVI Registry (NCT01368250), contributing valuable knowledge to the dynamic landscape of post-TAVR stroke risks.

Between February 2011 and June 2021, 11,957 consecutive TAVR patients (average age 81.8 ± 6.5 years, 48.0% female) were included. Standardized stroke ratios (SSRs) were calculated to compare stroke trends among TAVR patients with an age- and sex-matched general population in Switzerland, as per the 2019 Global Burden of Disease study.

A third of patients (32.3%) had a history of atrial fibrillation, and 11.8% had a history of cerebrovascular accident. The cumulative 30-day stroke incidence was 3.0%, with 69% occurring within the initial 48 hours post-TAVR. At 1 year, the stroke incidence was 4.3%, rising to 7.8% at 5 years. In the first two years post-TAVR, the stroke risk was significantly higher compared to the matched population: first year – SSR 7.26 (95% CI: 6.3-8.36) for males, 6.82 (95% CI: 5.97-7.79) for females; second year – SSR 1.98 (95% CI: 1.47-2.67) for males, 1.48 (95% CI: 1.09-2.02) for females. However, the risk normalized thereafter.

The authors concluded that in comparison to an age- and sex-matched population, TAVR patients face an elevated stroke risk for up to 2 years post-procedure, returning to a comparable level thereafter.

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Original article:  Okuno et al. J Am Coll Cardiol Intv 2023;16:2986–2996.

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