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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

Lookup NU author(s): Professor Azfar Zaman

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. 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.

Publication metadata

Author(s): Berkovitch A, Segev A, Maor E, Sedaghat A, Finkelstein A, Saccocci M, Kornowski R, Latib A, Hernandez JMDLT, Sondergaard L, Mylotte D, Royen NV, Zaman AG, Robert P, Sinning J-M, Steinvil A, Maisano F, Orvin K, Iannopollo G, Lee D-H, Backer OD, Mercanti F, van der Wulp K, Shome J, Tchetche D, Barbash IM

Publication type: Article

Publication status: Published

Journal: Journal of Personalized Medicine

Year: 2022

Volume: 12

Issue: 7

Online publication date: 28/06/2022

Acceptance date: 23/06/2022

Date deposited: 22/07/2022

ISSN (electronic): 2075-4426

Publisher: MDPI

URL: https://doi.org/10.3390/jpm12071056

DOI: 10.3390/jpm12071056

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