http://dgnews.docguide.com/transcatheter-versus-surgical-aortic-valve-replacement-increases-risk-subsequent-stroke?
By Brian Hoyle
SAN DIEGO, California -- October 18, 2017 -- In the year following transcatheter aortic valve replacement (TAVR), patients experience an approximate 20% increased risk of ischaemic stroke and an over 6-fold increased risk of haemorrhagic stroke compared with patients who underwent surgical aortic-valve replacement (SAVR), according to results of a large, nationwide study presented at the 142nd Annual Meeting of the American Neurological Association (ANA).
The risk of 1-year events was similar for patients undergoing a coronary-artery bypass graft (CABG) procedure versus percutaneous coronary intervention (PCI).
“Patient selection may impact this risk,” explained author Laura Stein, MD, Icahn School of Medicine at Mount Sinai, New York, New York, at a poster presentation here on October 15.
The risk of stroke following cardiac procedures is reported to be about 9%; however, this figure is based on a small number of patients, local rather than national scope, limited types of cardiac procedures, and a focus on the perioperative period and long-term periods following surgery.
Dr. Stein and colleagues sought to get a clearer picture of patients’ intermediate risk using data from the 2013 Nationwide Readmission Database (NRD). The NRD contains readmissions data for over 14 million insured and uninsured Americans. The team scrutinised the data standard codes for cardiac procedures, and then analysed relevant data to determine the risk of stroke for up to 1 year following TAVR vs SAVR, and CABG vs PCI.
The NRD data included 2,819,649 patients nationwide who had undergone medical procedure; of these, 653,216 underwent a cardiac procedure, 1,198,209 a non-cardiac procedure, and 968,224 some other medical procedure. The groups were similar in age, prevalence of obesity, and length of hospital stay following surgery.
Dr. Stein and colleagues observed that, compared with their non-cardiac counterparts, patients receiving a cardiac procedure were more likely to present with atrial fibrillation or flutter, to have carotid-artery disease, coagulation disorder, congestive heart failure, coronary-artery disease, and peripheral-artery disease. Those receiving a cardiac procedure also had a higher prevalence of diabetes, hypertension, hyperlipidaemia, and renal failure.
The cumulative risk of ischaemic and haemorrhagic stroke was greater after TAVR compared with SAVR in the unadjusted data as well as following adjustment for baseline vascular risk factors, hospital bed size, teaching-hospital status, income, risk of mortality / severity of illness, and the residence of each subject (urban or rural nationwide).
The fully adjusted data revealed a hazard ratio (HR) for ischaemic stroke after TAVR, compared with SAVR, of 1.86 (95% confidence interval [CI]: 1.12 to 3.08) (P = .016). The HR for haemorrhagic stroke comparing the same procedures was 6.17 (95% CI: 1.97 to 19.33) (P = .0018). There was no statistically significant difference in the risk of stroke when CABG was compared with PCI, with a similar 1-year risk of ischaemic stroke. The risk of haemorrhagic stroke was similar for CABG and PCI throughout the 1-year follow-up.
The reasons for the increased risk associated with TAVR remain unknown, the authors concluded, but need to be understood if interventions are to be developed.
Dr. Stein and colleagues suggested that patients might benefit from the development of a risk index calculator that would better define the risk of stroke following cardiac and non-cardiac surgeries.
[Presentation title: Intermediate Risk of Stroke Following Cardiac Procedures in a Nationally Representative Dataset. Abstract S162]
SAN DIEGO, California -- October 18, 2017 -- In the year following transcatheter aortic valve replacement (TAVR), patients experience an approximate 20% increased risk of ischaemic stroke and an over 6-fold increased risk of haemorrhagic stroke compared with patients who underwent surgical aortic-valve replacement (SAVR), according to results of a large, nationwide study presented at the 142nd Annual Meeting of the American Neurological Association (ANA).
The risk of 1-year events was similar for patients undergoing a coronary-artery bypass graft (CABG) procedure versus percutaneous coronary intervention (PCI).
“Patient selection may impact this risk,” explained author Laura Stein, MD, Icahn School of Medicine at Mount Sinai, New York, New York, at a poster presentation here on October 15.
The risk of stroke following cardiac procedures is reported to be about 9%; however, this figure is based on a small number of patients, local rather than national scope, limited types of cardiac procedures, and a focus on the perioperative period and long-term periods following surgery.
Dr. Stein and colleagues sought to get a clearer picture of patients’ intermediate risk using data from the 2013 Nationwide Readmission Database (NRD). The NRD contains readmissions data for over 14 million insured and uninsured Americans. The team scrutinised the data standard codes for cardiac procedures, and then analysed relevant data to determine the risk of stroke for up to 1 year following TAVR vs SAVR, and CABG vs PCI.
The NRD data included 2,819,649 patients nationwide who had undergone medical procedure; of these, 653,216 underwent a cardiac procedure, 1,198,209 a non-cardiac procedure, and 968,224 some other medical procedure. The groups were similar in age, prevalence of obesity, and length of hospital stay following surgery.
Dr. Stein and colleagues observed that, compared with their non-cardiac counterparts, patients receiving a cardiac procedure were more likely to present with atrial fibrillation or flutter, to have carotid-artery disease, coagulation disorder, congestive heart failure, coronary-artery disease, and peripheral-artery disease. Those receiving a cardiac procedure also had a higher prevalence of diabetes, hypertension, hyperlipidaemia, and renal failure.
The cumulative risk of ischaemic and haemorrhagic stroke was greater after TAVR compared with SAVR in the unadjusted data as well as following adjustment for baseline vascular risk factors, hospital bed size, teaching-hospital status, income, risk of mortality / severity of illness, and the residence of each subject (urban or rural nationwide).
The fully adjusted data revealed a hazard ratio (HR) for ischaemic stroke after TAVR, compared with SAVR, of 1.86 (95% confidence interval [CI]: 1.12 to 3.08) (P = .016). The HR for haemorrhagic stroke comparing the same procedures was 6.17 (95% CI: 1.97 to 19.33) (P = .0018). There was no statistically significant difference in the risk of stroke when CABG was compared with PCI, with a similar 1-year risk of ischaemic stroke. The risk of haemorrhagic stroke was similar for CABG and PCI throughout the 1-year follow-up.
The reasons for the increased risk associated with TAVR remain unknown, the authors concluded, but need to be understood if interventions are to be developed.
Dr. Stein and colleagues suggested that patients might benefit from the development of a risk index calculator that would better define the risk of stroke following cardiac and non-cardiac surgeries.
[Presentation title: Intermediate Risk of Stroke Following Cardiac Procedures in a Nationally Representative Dataset. Abstract S162]
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