Clinical Predictors for Procedural Stroke and Implications for Embolic Protection Devices during TAVR: Results from the Multicenter Transcatheter Aortic Valve Replacement In-Hospital Stroke (TASK) Study

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  • Anat Berkovitch
  • Amit Segev
  • Elad Maor
  • Alexander Sedaghat
  • Ariel Finkelstein
  • Matteo Saccocci
  • Ran Kornowski
  • Azeem Latib
  • Jose M.De La Torre Hernandez
  • Darren Mylotte
  • Niels Van Royen
  • Azfar G. Zaman
  • Pierre Robert
  • Jan Malte Sinning
  • Arie Steinvil
  • Francesco Maisano
  • Katia Orvin
  • Gianmarco Iannopollo
  • Dae Hyun Lee
  • Federico Mercanti
  • Kees van der Wulp
  • Joy Shome
  • Didier Tchétché
  • Israel M. Barbash

Background: Data to support the routine use of embolic protection devices for stroke prevention during transcatheter aortic valve replacement (TAVR) are controversial. Identifying patients at high risk for peri-procedural cerebrovascular events may facilitate effective patient selection for embolic protection devices during TAVR. Aim: To generate a risk score model for stratifying TAVR patients according to peri-procedural cerebrovascular events risk. Methods and results: A total of 8779 TAVR patients from 12 centers worldwide were included. Peri-procedural cerebrovascular events were defined as an ischemic stroke or a transient ischemic attack occurring ≤24 h from TAVR. The peri-procedural cerebrovascular events rate was 1.4% (n = 127), which was independently associated with 1-year mortality (hazards ratio (HR) 1.78, 95% confidence interval (CI) 1.06–2.98, p < 0.028). The TASK risk score parameters were history of stroke, use of a non-balloon expandable valve, chronic kidney disease, and peripheral vascular disease, and each parameter was assigned one point. Each one-point increment was associated with a significant increase in peri-procedural cerebrovascular events risk (OR 1.96, 95% CI 1.56–2.45, p < 0.001). The TASK score was dichotomized into very-low, low, intermediate, and high (0, 1, 2, 3–4 points, respectively). The high-risk TASK score group (OR 5.4, 95% CI 2.06–14.16, p = 0.001) was associated with a significantly higher risk of peri-procedural cerebrovascular events compared with the low TASK score group. Conclusions: The proposed novel TASK risk score may assist in the pre-procedural risk stratification of TAVR patients for peri-procedural cerebrovascular events.

OriginalsprogEngelsk
Artikelnummer1056
TidsskriftJournal of Personalized Medicine
Vol/bind12
Udgave nummer7
ISSN2075-4426
DOI
StatusUdgivet - 2022

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