دورية أكاديمية
Incidence, Predictors, and Prognostic Impact of Neurologic Events After TAVR According to VARC-3 Criteria.
| العنوان: | Incidence, Predictors, and Prognostic Impact of Neurologic Events After TAVR According to VARC-3 Criteria. |
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| المؤلفون: | Avvedimento M; Quebec Heart and Lung Institute, Laval University, Quebec City, Canada., Cepas-Guillén P; Quebec Heart and Lung Institute, Laval University, Quebec City, Canada., Garcia CB; Quebec Heart and Lung Institute, Laval University, Quebec City, Canada., Franzone A; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy., Sorrentino S; Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy., Indolfi C; Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy., Esposito G; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy., Mohammadi S; Quebec Heart and Lung Institute, Laval University, Quebec City, Canada., Pelletier-Beaumont E; Quebec Heart and Lung Institute, Laval University, Quebec City, Canada., Rodés-Cabau J; Quebec Heart and Lung Institute, Laval University, Quebec City, Canada; Clinic Barcelona, Barcelona, Spain. Electronic address: josep.rodes@criucpq.ulaval.ca. |
| المصدر: | JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2024 Aug 12; Vol. 17 (15), pp. 1795-1807. |
| نوع المنشور: | Journal Article; Multicenter Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 101467004 Publication Model: Print Cited Medium: Internet ISSN: 1876-7605 (Electronic) Linking ISSN: 19368798 NLM ISO Abbreviation: JACC Cardiovasc Interv Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York : Elsevier |
| مواضيع طبية MeSH: | Aortic Valve Stenosis*/surgery , Aortic Valve Stenosis*/mortality , Aortic Valve Stenosis*/diagnostic imaging , Aortic Valve Stenosis*/physiopathology , Transcatheter Aortic Valve Replacement*/adverse effects , Transcatheter Aortic Valve Replacement*/mortality , Ischemic Attack, Transient*/etiology , Ischemic Attack, Transient*/mortality , Ischemic Attack, Transient*/epidemiology , Severity of Illness Index* , Stroke*/mortality , Stroke*/etiology , Stroke*/epidemiology, Humans ; Male ; Risk Factors ; Female ; Incidence ; Aged ; Aged, 80 and over ; Time Factors ; Risk Assessment ; Treatment Outcome ; Delirium/epidemiology ; Delirium/etiology ; Delirium/diagnosis ; Delirium/mortality ; Databases, Factual ; Aortic Valve/surgery ; Aortic Valve/physiopathology ; Aortic Valve/diagnostic imaging |
| مستخلص: | Background: The Valve Academic Research Consortium (VARC)-3 definition for neurologic events after transcatheter aortic valve replacement (TAVR) lacks clinical validation. Objectives: This study sought to determine the incidence, predictors, and clinical impact of neurologic events following TAVR as defined by VARC-3 criteria. Methods: This was a multicenter study including 2,924 patients with severe aortic stenosis undergoing TAVR. Based on Neurologic Academic Research Consortium (NeuroARC) classification, neurologic events were classified as NeuroARC type 1 (stroke), NeuroARC type 2 (covert central nervous system injury), and NeuroARC type 3 (transient ischemic attack and delirium). Baseline, procedural, and follow-up data were prospectively collected in a dedicated database. Results: After a median follow-up of 13 (7-37) months, neurologic events occurred in 471 patients (16.1%), NeuroARC type 1, 2, and 3 in 37.4%, 4.7%, and 58.0% of cases, respectively, and the majority (58.6%) were periprocedural. Advanced age, chronic kidney disease, atrial fibrillation, major vascular complications, and in-hospital bleeding determined an increased risk of periprocedural events (P < 0.03 for all). Neurologic events occurring during the periprocedural time frame were independently associated with a substantial increase in mortality at 1 year after the intervention (HR: 1.91; 95% CI: 1.23-2.97; P = 0.004). However, although NeuroARC type 1 was associated with an increased mortality risk (IRR: 3.38; 95% CI: 2.30-5.56; P < 0.001 and IRR: 21.7; 95% CI: 9.63-49.1; P < 0.001 for ischemic and hemorrhagic stroke, respectively), the occurrence of NeuroARC type 3 events had no impact on mortality. Conclusions: Neurologic events after TAVR were associated with poorer short- and long-term survival. This correlation was related to the type of NeuroARC event defined by the VARC-3 criteria. Given the negative impact on clinical outcomes, every attempt should be made to reduce the risk of neurologic complications after TAVR. Competing Interests: Funding Support and Author Disclosures Dr Cepas-Guillén has received a grant from the Fundación Alfonso Martín Escudero. Dr Rodés-Cabau has received institutional research grants and speaker/consultant fees from Edwards Lifesciences and Medtronic, and holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Interventions (Laval University). All other authors have reported that they have no relationships relevant to the contents of this paper. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: TAVR; TIA; VARC-3 criteria; delirium; neurologic event(s); stroke; transcatheter aortic valve replacement |
| تواريخ الأحداث: | Date Created: 20240814 Date Completed: 20240814 Latest Revision: 20240814 |
| رمز التحديث: | 20240815 |
| DOI: | 10.1016/j.jcin.2024.05.040 |
| PMID: | 39142756 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1876-7605 |
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| DOI: | 10.1016/j.jcin.2024.05.040 |