Incidence and Clinical Impact of Stroke Complicating Transcatheter Aortic Valve Implantation: Results From the German TAVI Registry
Incidence and Clinical Impact of Stroke Complicating Transcatheter Aortic Valve Implantation: Results From the German TAVI Registry
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DOI：
10.1002/ccd.26612
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发表时间：
2016-10-01
影响因子：
2.3
通讯作者：
Zahn, Ralf
中科院分区：
文献类型：
--
作者：
Werner, Nicolas;Zeymer, Uwe;Zahn, Ralf
近年来，经导管主动脉瓣置入术(TAVI)已成为一种安全、有效的治疗方法，适用于手术风险较高的重度、症状性主动脉瓣狭窄患者。然而，除了微创的特点外，TAVI仍然是一种侵入性手术，通常在人群中进行，存在中风等血管并发症的巨大风险。在临床实践中，卒中是一种罕见但严重的经血管介入治疗并发症，具有较高的发病率和死亡率。尽管过去几年在许多领域进行了广泛的临床研究，但目前关于卒中并发TAVI的发病率和临床危险因素的数据仍然很少。方法我们分析了2009年1月至2010年6月在德国前瞻性多中心TAVI登记的30个地点的1.413例TAVI的数据。结果在现实世界中，卒中并发TAVI的总发生率为3.2%(n=45/1.413)。40%的脑血管事件被归类为短暂性脑缺血发作(TIA)，症状持续24小时(27/45)。所有卒中并发TAVI的50%被归类为导致患者显著残疾的主要卒中，这些患者在这种并发症中存活下来(改良分级标准3-6)。卒中/短暂性脑缺血发作患者的住院死亡率为28.9%，而非卒中/短暂性脑缺血发作患者的住院死亡率为6.9%，1年死亡率为46.7%，而非卒中/短暂性脑缺血发作患者的1年死亡率为18.6%。在多因素分析中，卒中和肾损害是卒中并发TVI的唯一独立预测因素。结论卒中并发TAVI是一种严重的并发症，即使在日常实践中也有临床相关的发生率，导致30d死亡率增加5倍，患者的发病率和致残率显著增加，在这种毁灭性的并发症中幸存下来。需要进一步的研究来确定危险因素和减少TAVI后卒中的方法。(C)2016威利期刊公司。
BackgroundTranscatheter aortic valve implantation (TAVI) has emerged as a safe and effective treatment for patients with severe, symptomatic aortic valve stenosis at high surgical risk over the last years. However, besides its minimal invasive character, TAVI still is an invasive procedure usually performed in a population, carrying a substantial risk for vascular complications, like stroke. Stroke is known to be a rare but serious complication of transvascular interventions in clinical practice, which is associated with high morbidity and mortality rates. Despite broad clinical research in many fields of TAVI over the last years, only sparse data still exist on the incidence and clinical risk factors of stroke complicating TAVI in clinical practice today.MethodsWe analyzed data of 1.413 TAVIs, which were enrolled at 30 sites into the prospective and multicenter German TAVI Registry from January 2009 until June 2010.ResultsThe overall incidence of cerebrovascular events complicating TAVI was 3.2% (n=45/1.413) in a real-world population today. 40% of all cerebrovascular events were classified as transient ischemic attacks (TIA) with symptoms lasting24 hr (27/45). All strokes complicating TAVI of 50% were classified as major strokes leading to notable disability in patients, who survive this complication (Modified Ranking Scale 3-6). In-hospital mortality rate in patients with stroke/TIA was 28.9%, compared to 6.9% in patients without stroke/TIA and 1-year mortality rate 46.7% versus 18.6%, respectively. In multivariate analysis, prior stroke and renal impairment were found as the only independent predictors for stroke complicating TAVI.ConclusionsStroke complicating TAVI is a serious complication with a clinically relevant incidence even in daily practice leading to a fivefold increase in 30-day-mortality rate, as well as a significant increase in morbidity and disability in patients, who survive this devastating complication. Further research is needed to identify risk factors and ways to reduce stroke after TAVI. (c) 2016 Wiley Periodicals, Inc.