Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
Publication/Presentation Date
4-1-2019
Abstract
BACKGROUND: Stroke is a serious complication after transcatheter aortic valve replacement (TAVR), yet predictive models are not available. A new risk model for in-hospital stroke after TAVR was developed and used to estimate site-specific performance.
METHODS: We included 97,600 TAVR procedures from 521 sites in The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry from July 2014 to June 2017. Association between baseline covariates and in-hospital stroke was estimated by logistic regression. Discrimination was evaluated by C-statistic. Calibration was tested internally via cross-validation. Hierarchical modeling was used to estimate risk-adjusted site-specific performance.
RESULTS: Median age was 82 years, 44,926 (46.0%) were women, and 1,839 (1.9%) had in-hospital stroke. Covariates associated with stroke (odds ratio) included transapical access (1.44), access excluding transapical and transfemoral (1.77), prior stroke (1.57), prior transient ischemic attack (1.50), preprocedural shock, inotropes or mechanical assist device (1.48), smoking (1.28), porcelain aorta (1.23), peripheral arterial disease (1.21), age per 5 years (1.11), glomerular filtration rate per 5 mL/min (0.97), body surface area per m
CONCLUSIONS: A risk model for in-hospital stroke after TAVR was developed from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry and used to estimate site-specific stroke performance. This model can serve as a valuable resource for quality improvement, clinical decision making, and patient counseling.
Volume
107
Issue
4
First Page
1097
Last Page
1103
ISSN
1552-6259
Published In/Presented At
Thourani, V. H., O'Brien, S. M., Kelly, J. J., Cohen, D. J., Peterson, E. D., Mack, M. J., Shahian, D. M., Grover, F. L., Carroll, J. D., Brennan, J. M., Forcillo, J., Arnold, S. V., Vemulapalli, S., Fitzgerald, S., Holmes, D. R., Bavaria, J. E., & Edwards, F. H. (2019). Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. The Annals of thoracic surgery, 107(4), 1097–1103. https://doi.org/10.1016/j.athoracsur.2018.11.013
Disciplines
Medicine and Health Sciences
PubMedID
30529671
Department(s)
Department of Surgery
Document Type
Article