title: Predictors of Early Cerebrovascular Events in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement.
abstract: Identifying transcatheter aortic valve replacement (TAVR) patients at high risk for cerebrovascular events (CVE) is of major clinical relevance. However, predictors have varied across studies.
  
  
  
  The purpose of this study was to analyze the predictors of 30-day CVE post-TAVR.
  
  
  
  A systematic review of studies that reported the incidence of CVE post-TAVR while providing raw data for predictors of interest was performed. Data on study, patient, and procedural characteristics were extracted. Crude risk ratios (RRs) and 95% confidence intervals for each predictor were calculated.
  
  
  
  Sixty-four studies involving 72,318 patients (2,385 patients with a CVE within 30 days post-TAVR) were analyzed. Incidence of CVE ranged from 1% to 11% (median 4%) without significant differences between single and multicenter studies, or according to CVE adjudication availability. The summary RRs indicated lower risk for men (RR: 0.82; p = 0.02) and higher risk for patients with chronic kidney disease (RR: 1.29; p = 0.03) and with new-onset atrial fibrillation post-TAVR (RR: 1.85; p = 0.005), and for procedures performed within the first half of center experience (RR: 1.55; p = 0.003). The use of balloon post-dilation tended to be associated with a higher risk of CVE (RR: 1.43; p = 0.07). Valve type (balloon-expandable vs. self-expandable, p = 0.26) and approach (transfemoral vs. nontransfemoral, p = 0.81) did not predict CVE.
  
  
  
  Female sex, chronic kidney disease, enrollment date, and new-onset atrial fibrillation were predictors of CVE post-TAVR. This study provides effect estimates to identify high-risk TAVR patients for early CVE, providing possible guidance for tailored preventive strategies.
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Rennes 1 University, Signal and Image Processing Laboratory, Rennes, France.
authors: Vincent
authors: V
authors: Auffret
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Ander
authors: A
authors: Regueiro
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: María
authors: M
authors: Del Trigo
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Omar
authors: O
authors: Abdul-Jawad Altisent
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Francisco
authors: F
authors: Campelo-Parada
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Olivier
authors: O
authors: Chiche
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Rishi
authors: R
authors: Puri
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors: Josep
authors: J
authors: Rodés-Cabau
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications* / Q000601:surgery; D014943:Global Health; D006801:Humans; D015994:Incidence; D011379:Prognosis; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement
keywords: aortic stenosis; cerebrovascular events; predictors; stroke; transcatheter aortic valve implantation