Valvular & structural heart diseaseCohort study
The Association Between Hospital Comprehensive Stroke Center Designation Status and Stroke Rate Reporting in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry After Transcatheter Aortic Valve Replacement: Implications for Hospital Performance Assessment
- Retrospective registry cohort study
- multivariable hierarchical models
- falsification end points
Authors' conclusion
CSC hospital status and participation in TAVR trials are significant predictors unique for stroke. Correcting for the association of CSC status on stroke rate resulted in an estimated 8 of 153 hospitals improving their TVTR 30-day composite model performance.
Study context
- Population
- Consecutive transcatheter aortic valve replacement (TAVR) cases in the STS/ACC TVT Registry, January 2016 to June 2023, at sites reporting ≥1 year with ≥20 TAVR procedures
- Participants
- 525,919 cases · 800 sites
- Exposure
- Comprehensive Stroke Center (CSC)-designated vs non-CSC hospitals
- Outcome
- In-hospital stroke rate
Main finding
As reported in the abstract
In-hospital strokes reported (all TAVRs)
8284 (1.6%)
CSC status independent predictor of in-hospital stroke rate
P=0.033
Participation in TAVR trials independent predictor of in-hospital stroke rate
P=0.012
Observational data: associations, not effects.
Secondary outcomes
Disabling stroke
- Disabling strokes (all TAVRs)
- 4733 (0.9%)
- CSC status independent predictor
- P = 0.033
- Participation in TAVR trials independent predictor
- P = 0.007
30-day stroke
- Strokes within 30 days (all TAVRs)
- 10 963 (2.1%)
- Strokes after discharge
- 2679 (0.5%)
- Participation in TAVR trials independent predictor
- P = 0.039
- Operator volume independent predictor
- P = 0.041
Falsification end points (major bleeding, death, acute renal failure, composite)
- CSC status and TAVR trial participation not predictors
- P = NS
Hospital performance in TVTR 30-day composite model after correcting for CSC status
- CSC hospitals with performance improvement
- 8 of 153
Original publication
Summarised from the published abstract; every number is checked against it