Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada.
Circulation. 2012 Dec 18;126(25):3041-53. doi: 10.1161/CIRCULATIONAHA.112.110981. Epub 2012 Nov 13.
The objective of this study was to evaluate the timing, predictive factors, and prognostic value of cerebrovascular events (CVEs) after transcatheter aortic valve implantation.
The study included 1061 consecutive patients who underwent transcatheter aortic valve implantation with a balloon-expandable (64%) or self-expandable (36%) valve. CVEs were classified as acute (≤24 hours), subacute (1-30 days), or late (>30 days). CVEs occurred in 54 patients (5.1%; stroke, 4.2%) within 30 days after transcatheter aortic valve implantation (acute in 54% of cases). The predictors of acute CVEs were balloon postdilation of the valve prosthesis (odds ratio, 2.46; 95% confidence interval,1.07-5.67) and valve dislodgment/embolization (odds ratio, 4.36; 95% CI, 1.21-15.69); new-onset atrial fibrillation (odds ratio, 2.76; 95% CI, 1.11-6.83) was a predictor of subacute CVEs. Late CVEs occurred in 35 patients (3.3%; stroke, 2.1%) at a median follow-up of 12 months (3-23 months). The predictors of late CVEs were chronic atrial fibrillation (2.84; 95% CI, 1.46-5.53), peripheral vascular disease (hazard ratio, 2.02; 95% CI, 1.02-3.97), and prior cerebrovascular disease (hazard ratio, 2.04; 95% CI, 1.01-4.15). Major stroke was associated with 30-day (odds ratio, 7.43; 95% CI, 2.45-22.53) and late (hazard ratio, 1.75; 95% CI, 1.01-3.04) mortality.
In a large cohort of patients undergoing transcatheter aortic valve implantation, the rates of acute and subacute CVEs were 2.7% and 2.4%, respectively. While balloon postdilation and valve dislodgment/embolization were the predictors of acute CVEs, new-onset atrial fibrillation determined a higher risk for subacute events. Late events were determined mainly by a history of chronic atrial fibrillation and peripheral and cerebrovascular disease. The occurrence of major stroke was associated with increased early and late mortality. These results provide important insights for the implementation of preventive measures for CVEs after transcatheter aortic valve implantation.
本研究旨在评估经导管主动脉瓣置换术后脑血管事件（CVE）的发生时间、预测因素及预后价值。
该研究纳入了 1061 例连续接受经导管主动脉瓣置换术的患者，其中球囊扩张型（64%）和自膨式（36%）瓣膜各占一半。CVE 分为急性（≤24 小时）、亚急性（1-30 天）和晚期（>30 天）。术后 30 天内，54 例（5.1%；卒中 4.2%）患者发生 CVE（54%为急性）。急性 CVE 的预测因素包括球囊后扩张瓣膜（比值比，2.46；95%置信区间，1.07-5.67）和瓣膜移位/栓塞（比值比，4.36；95%置信区间，1.21-15.69）；新发心房颤动（比值比，2.76；95%置信区间，1.11-6.83）是亚急性 CVE 的预测因素。中位随访 12 个月（3-23 个月）时，35 例（3.3%；卒中 2.1%）患者发生晚期 CVE。晚期 CVE 的预测因素包括慢性心房颤动（2.84；95%置信区间，1.46-5.53）、外周血管疾病（风险比，2.02；95%置信区间，1.02-3.97）和既往脑血管疾病（风险比，2.04；95%置信区间，1.01-4.15）。大卒中和 30 天（比值比，7.43；95%置信区间，2.45-22.53）及晚期（风险比，1.75；95%置信区间，1.01-3.04）死亡率相关。
在接受经导管主动脉瓣置换术的大量患者中，急性和亚急性 CVE 的发生率分别为 2.7%和 2.4%。球囊后扩张和瓣膜移位/栓塞是急性 CVE 的预测因素，新发心房颤动是亚急性事件的高风险因素。晚期事件主要由慢性心房颤动、外周血管和脑血管疾病病史决定。大卒中的发生与早期和晚期死亡率增加相关。这些结果为经导管主动脉瓣置换术后 CVE 的预防措施提供了重要的见解。
