Incidence and predictors for symptomatic stroke within 30 days after transcatheter aortic valve implantation: insights from the LAPLACE-TAVI registry

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology Pub Date : 2026-08-01 Epub Date: 2026-02-23 DOI:10.1016/j.jjcc.2026.02.007

Hiroaki Yokoyama MD, PhD, FJCC, Ken Yamazaki MD, PhD, Shun Shikanai MD, PhD, Misato Hamadate MD, PhD, Michiko Tsushima MD, PhD, Noritomo Narita MD, PhD, Maiko Senoo MD, PhD, Hiroaki Ichikawa MD, PhD, Shuji Shibutani MD, PhD, Kenji Hanada MD, PhD, Yoshiaki Saito MD, PhD, Kenyu Murata MD, PhD, Yuki Imamura MD, PhD, Ryosuke Higuchi MD, Kenichi Hagiya MD, Itaru Takamisawa MD, Mamoru Nanasato MD, PhD, FJCC, Nobuo Iguchi MD, PhD, FJCC, Morimasa Takayama MD, PhD, FJCC, Jun Shimizu MD, PhD, Hirofumi Tomita MD, PhD, FJCC

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引用次数: 0

Abstract

Background

Stroke is a devastating complication after transcatheter aortic valve implantation (TAVI), however contemporary data on its incidence and predictors remain limited.

Methods and results

We analyzed 4774 consecutive patients undergoing TAVI between April 2010 and June 2024 in the prospective multicenter LAPLACE-TAVI registry. Patients with valve-in-valve procedures, investigational devices, or missing data were excluded. The primary endpoint was symptomatic stroke within 30 days after TAVI. Patients were stratified into 2 groups: Stroke (n = 68) and non-Stroke groups (n = 4706). Baseline characteristics, TAVI procedural data, and clinical outcomes were compared. Multivariate logistic regression was performed to identify predictors of periprocedural stroke.

Thirty-day symptomatic stroke occurred in 1.4% of study patients. Stroke patients more frequently had previous stroke, peripheral artery disease (PAD), frailty, and higher Society of Thoracic Surgeons (STS) scores. Nearly 90% of stroke events occurred within 5 days after TAVI. Use of self-expanding (SE) valves was more common in the Stroke group (47% vs. 32%). On multivariate analysis, PAD [odds ratio (OR): 1.70, 95% confidence interval (CI): 1.10–2.63], higher STS score (OR: 1.03, 95%CI: 1.00–1.05), and SE valve use (OR: 1.71, 95%CI: 1.16–2.53) were independent predictors.

Conclusions

In this large multicenter registry, the 30-day incidence of symptomatic stroke after TAVI was 1.4%. PAD, higher STS score, and SE valve use were independent predictors. Careful patient selection and procedural planning are warranted.

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经导管主动脉瓣植入术后30天内症状性卒中的发生率和预测因素：来自LAPLACE-TAVI注册的见解

背景：卒中是经导管主动脉瓣植入术（TAVI）后的一种破坏性并发症，然而其发病率和预测因素的当代数据仍然有限。方法和结果：我们分析了2010年4月至2024年6月期间4774名连续接受TAVI的前瞻性多中心LAPLACE-TAVI注册患者。排除了瓣膜内手术、研究性装置或缺失数据的患者。主要终点是TAVI后30 天内的症状性卒中。将患者分为脑卒中组（n = 68）和非脑卒中组（n = 4706）。比较基线特征、TAVI程序数据和临床结果。采用多变量逻辑回归来确定围手术期卒中的预测因素。30天的症状性卒中发生率为1.4%。卒中患者既往卒中、外周动脉疾病（PAD）、身体虚弱和胸外科学会（STS）评分较高的发生率更高。近90%的中风事件发生在TAVI后5 天内。自膨胀（SE）瓣膜的使用在卒中组更为常见（47%对32%）。在多因素分析中，PAD[比值比（OR）： 1.70, 95%可信区间（CI）： 1.10-2.63]、较高的STS评分（OR: 1.03, 95%CI: 1.00-1.05）和SE阀使用（OR: 1.71, 95%CI: 1.16-2.53）是独立预测因子。结论：在这个大型多中心登记中，TAVI后30天症状性卒中的发生率为1.4%。PAD、较高的STS评分和SE阀的使用是独立的预测因素。谨慎的病人选择和程序规划是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

8.00%

发文量

202

审稿时长

29 days

期刊介绍： The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.

Incidence and predictors for symptomatic stroke within 30 days after transcatheter aortic valve implantation: insights from the LAPLACE-TAVI registry

Abstract

Background

Methods and results

Conclusions

Incidence and predictors for symptomatic stroke within 30 days after transcatheter aortic valve implantation: insights from the LAPLACE-TAVI registry