美国俄亥俄州心脏与血管研究所Chetan P. Huded等研究人员，研究了经导管主动脉瓣置换术与术后早期卒中的关系。相关论文于2019年6月18日发表于国际顶尖学术期刊《美国医学会杂志》杂志上。

本研究评估了在美国使用经导管主动脉瓣置换术（TAVR）治疗的头5年内术后30天内发生卒中的趋势，研究了卒中与30天死亡率的关系，以及医疗治疗与30天卒中风险的关系。回顾性队列研究包括2011年11月9日至2017年5月31日期间内，521家美国胸外科学会/美国心脏病学院经导管瓣膜治疗注册中心医院的101430名接受了股骨和非股骨TAVR治疗的患者，随访30天至2017年6月30日结束。研究结果显示30天后，2290例患者(2.3%) (95% CI, 2.2%-2.4%)发生各种类型的卒中，373例患者 (0.4%) (95% CI, 0.3%-0.4%) 发生短暂性脑缺血。研究期间，所有患者(P趋势=0.22)和股动脉入路亚组(P趋势=0.47)的30天卒中率趋势稳定。在30天内发生卒中患者中，1119例(48.9%)发生于TAVR术后第1天内，1567例(68.4%)发生于TAVR术后3天内。卒中的发生与30天死亡率显著增加相关，2290名卒中患者中有383例（16.7%）死亡，而没有发生卒中的99,140名患者中有3662例（3.7%）死亡（校正HR=6.1, 95% CI, 5.4-6.8;p＜0.001）。倾向评分匹配分析后，研究发现股动脉与非股动脉入路组患者的30天卒中风险与出院时是否接受双重抗血小板治疗，以及是否口服抗凝治疗都无显著关系。

据介绍，减少术后卒中对提高经导管主动脉瓣置换术(TAVR)的安全性具有重要意义。

附：英文原文

Title: Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke

Author: Chetan P. Huded, MD, MSc; E. Murat Tuzcu, MD; Amar Krishnaswamy, MD; Stephanie L. Mick, MD; Neal S. Kleiman, MD; Lars G. Svensson, MD, PhD; John Carroll, MD; Vinod H. Thourani, MD; Ajay J. Kirtane, MD, SM; Pratik Manandhar, MS; Andrzej S. Kosinski, PhD; Sreekanth Vemulapalli, MD; Samir R. Kapadia, MD

Issue&Volume: Vol 321，No.23，2019

Abstract: Importance  Reducing postprocedural stroke is important to improve the safety of transcatheter aortic valve replacement (TAVR).

Objective  This study evaluated the trends of stroke occurring within 30 days after the procedure during the first 5 years TAVR was used in the United States, the association of stroke with 30-day mortality, and the association of medical therapy with 30-day stroke risk.

Design, Setting, and Participants  Retrospective cohort study including 101?430 patients who were treated with femoral and nonfemoral TAVR at 521 US hospitals in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry from November 9, 2011, through May 31, 2017. Thirty-day follow-up ended June 30, 2017.

Exposures  TAVR.

Main Outcomes and Measures  The rates of 30-day transient ischemic attack and stroke were assessed. Association of stroke with 30-day mortality and association of antithrombotic medical therapies with postdischarge 30-day stroke were assessed with a Cox proportional hazards model and propensity-score matching, respectively.

Results  Among 101?430 patients included in the study (median age, 83 years [interquartile range {IQR}, 76-87 years]; 47?797 women [47.1%]; and 85?147 patients [83.9%] treated via femoral access), 30-day postprocedure follow-up data was assessed in all patients. At day 30, there were 2290 patients (2.3%) with a stroke of any kind (95% CI, 2.2%-2.4%), and 373 patients (0.4%) with transient ischemic attacks (95% CI, 0.3%-0.4%) . During the study period, 30-day stroke rates were stable without an increasing or decreasing trend in all patients (P for trend = .22) and in the large femoral access subgroup (P trend = .47). Among cases of stroke within 30 days, 1119 strokes (48.9%) occurred within the first day and 1567 (68.4%) within 3 days following TAVR. The occurrence of stroke was associated with a significant increase in 30-day mortality: 383 patients (16.7%) of 2290 who had a stroke vs 3662 patients (3.7%) of 99?140 who did not have a stroke died (P < .001; risk-adjusted hazard ratio [HR], 6.1 [95% CI, 5.4-6.8]; P < .001). After propensity-score matching, 30-day stroke risk was not associated with whether patients in the femoral cohort were (0.55%) or were not (0.52%) treated with dual antiplatelet therapy at hospital discharge (HR, 1.04; 95% CI, 0.74-1.46) nor was it associated with whether patients in the nonfemoral cohort were (0.71%) or were not (0.69%) treated with dual antiplatelet therapy (HR, 1.02; 95% CI, 0.54-1.95). Similarly, 30-day stroke risk was not associated with whether patients in the femoral cohort were (0.57%) or were not (0.55) treated with oral anticoagulant therapy at hospital discharge (HR, 1.03; 95% CI, 0.73-1.46) nor was it associated with whether patients in the nonfemoral cohort were (0.75%) or were not (0.82%) treated with an oral anticoagulant (HR, 0.93; 95% CI, 0.47-1.83).

Conclusions and Relevance  Between 2011 and 2017, the rate of 30-day stroke following transcatheter aortic valve replacement in a US registry population remained stable.

DOI: 10.1001/jama.2019.7525

Source: https://jamanetwork.com/journals/jama/article-abstract/2735820