NCDR Study Finds No Association Between Carotid Artery Disease, Stroke Risk in TAVR Patients

The presence of carotid artery disease in TAVR patients may not be associated with an increased risk of stroke or mortality at 30 days and one year after undergoing TAVR, according to a study published July 11 in Circulation: Cardiovascular Interventions.

Ajar Kochar, MD, et al., looked at 29,143 TAVR patients from 390 U.S. sites enrolled in the STS/ACC TVT Registry. Registry data were linked with Centers for Medicare and Medicaid Services (CMS) claims data to determine 30-day and one-year stroke and mortality outcomes.

According to the results, 22 percent of patients had carotid artery disease at the time of the TAVR procedure – 17.2 percent had moderate carotid artery disease, 3.2 percent had severe carotid artery disease, and 1.6 percent had occlusive carotid artery disease. Patients with carotid artery disease at baseline were more likely to have a history of hypertension, diabetes, stroke or myocardial infraction.

After one year, the primary endpoint of incidence of stroke was 4.5 percent among patients with carotid artery disease vs. 4.1 percent among patients without. A secondary endpoint of all-cause mortality was 21.5 percent for those with carotid artery disease vs. 19.9 percent for those without.

In terms of 30-day outcomes, stroke rate was 3.1 percent among patients with carotid artery disease vs. 2.4 percent among patients without; mortality was 6.1 percent for patients with carotid artery disease vs. 4.9 percent without.

Although patients with carotid artery disease had higher cumulative incidence rates of stroke and mortality at 30 days and one year, the authors explain that the differences were not statistically significant after adjusting for patient characteristics.

The researchers conclude that although stroke continues to be a complication in post-TAVR patients, the study suggests that "post-TAVR stroke seems to be because of mechanisms other than carotid artery disease." They add that moving forward, their research could be "helpful in focusing attention toward other stroke reduction strategies."

Keywords: Transcatheter Aortic Valve Replacement, Stroke, Medicare, Medicaid, Carotid Artery Diseases, Registries, Diabetes Mellitus, Hypertension, National Cardiovascular Data Registries, STS/ACC TVT Registry

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