Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry

Thourani and colleagues used data from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry to develop a risk model for in-hospital stroke after transcatheter aortic valve replacement (TAVR), a serious complication. Of the 97,600 TAVR procedures performed between 2014 and 2017 that were included in the analysis, 1,839 patients experienced in-hospital stroke. The authors limited covariate selection to patient demographics and baseline characteristics—with the one exception being access strategy—to increase the usefulness of the model prior to a procedure. Predictors for increased stroke risk included alternative access, prior stroke, procedural acuity, smoking, porcelain aorta, peripheral artery disease, and advanced age.
Additionally, the authors report that patients at 10 of the 521 participating sites were found to have significantly higher odds ratios for stroke than the other sites. They note that the model thus serves as a resource for quality improvement as well as for clinical decision making and patient counseling.