Valvular & structural heart diseaseCohort study
Stroke after transcatheter aortic valve implantation: incidence, temporal trends and predictors
- nationwide cohort
- SWEDEHEART registry
- Bayesian binomial regression
- hierarchical Bayesian logistic regression with a centre-level random intercept
- multivariable Bayesian Cox model with a 30-day landmark
Authors' conclusion
In this nationwide cohort, the incidence of early stroke after TAVI declined over time, partly reflecting changes in patient selection towards lower-risk profiles, with additional improvements in TAVI practice likely contributing. Despite this, early stroke remains strongly associated with excess mortality, underscoring the need for continued refinement of procedural strategies and targeted risk mitigation.
Study context
- Population
- All patients undergoing transcatheter aortic valve implantation (TAVI) in Sweden between 2008 and 2023
- Participants
- 11,957 patients
- Exposure
- Temporal trends in 30-day stroke after TAVI, 2008 to 2023
- Outcome
- 30-day ischaemic or haemorrhagic stroke
- Follow-up
- 30 days
Main finding
As reported in the abstract
Odds ratio
0.97
95% credible interval CI 0.95–1.00
Per year, as printed
- Stroke within 30 days
- 374 (3.1%)
- Stroke during index hospitalisation
- 310
- Incidence of 30-day stroke in 2008
- 5.3%
- Incidence of 30-day stroke in 2023
- 3.2%
Observational data: associations, not effects.
Further findings
Contributors to temporal decline
- The temporal decline was partly explained by changes in patient case-mix, particularly declining EuroSCORE (European System for Cardiac Operative Risk Evaluation) II
- Centre procedural volume did not modify temporal trends; trend similar across low-volume, medium-volume and high-volume centres
Predictors of 30-day stroke
- Prior stroke, female sex, porcelain aorta and self-expanding valves associated with a higher probability of 30-day stroke
- TAVI-in-SAVR (transcatheter aortic valve implantation in surgical aortic valve replacement) procedures associated with a lower stroke risk
- exploratory analyses
30-day and 1-year mortality
- Stroke within 30 days was associated with markedly higher 30-day and 1-year mortality
Original publication
Summarised from the published abstract; every number is checked against it