Study Evaluates Association of Carotid Disease on TAVR Outcomes

July 16, 2018—Ajar Kochar, MD, et al conducted a study of stroke and cardiovascular outcomes in patients with carotid disease undergoing transcatheter aortic valve replacement (TAVR). The findings are available online in Circulation: Cardiovascular Interventions.

To ascertain 30-day and 1-year cumulative incidence rates of stroke and all-cause mortality, the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapies Registry—consisting of data from consecutive TAVR cases in the United States during the years 2013 to 2015—was linked to Medicare claims data.

As summarized in Circulation: Cardiovascular Interventions, the investigators compared 30-day and 1-year stroke and mortality outcomes between patients with no carotid disease and patients with moderate, severe, and occlusive carotid disease and adjusted for baseline covariates using proportional hazards models.

Among 29,143 patients undergoing TAVR across 390 sites in the United States, 22% had carotid disease. Patients with carotid disease had higher rates of previous hypertension, diabetes mellitus, stroke, and myocardial infarction.

Observed in-hospital stroke rates were 2% among patients with no carotid disease, 2.5% with moderate carotid disease, 3% among severe carotid disease, and 2.6% among occlusive carotid disease.

The investigators reported that there was no association between the presence of carotid disease and 30-day stroke (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.94–1.43) or mortality (adjusted HR, 1.10; 95% CI, 0.95–1.28). There was no association between carotid disease and 1-year stroke (adjusted HR, 1.03; 95% CI, 0.86–1.24) or mortality (adjusted HR, 1.02; 95% CI, 0.93–1.12). Furthermore, there was no significant risk-adjusted association between the severity of carotid disease and 30-day or 1-year stroke or mortality.

Carotid disease is common among TAVR patients—it is present in one of five patients—but was not associated with an increased risk of stroke or mortality at 30 days or 1 year. Post-TAVR stroke seems to be because of mechanisms other than carotid disease, concluded the investigators in Circulation: Cardiovascular Interventions.