Risk factors of ischemic stroke in patients with atrial fibrillation after transcatheter aortic valve implantation from the randomized ENVISAGE-TAVI AF trial

• Verfasst von: Hengstenberg, Christian [VerfasserIn]
• Verfasst von: Unverdorben, Martin [VerfasserIn]
• Verfasst von: Möllmann, Helge [VerfasserIn]
• Verfasst von: Van Mieghem, Nicolas M. [VerfasserIn]
• Verfasst von: Thiele, Holger [VerfasserIn]
• Verfasst von: Nordbeck, Peter [VerfasserIn]
• Verfasst von: Rassaf, Tienush [VerfasserIn]
• Verfasst von: Moreno, Raul [VerfasserIn]
• Verfasst von: Mehran, Roxana [VerfasserIn]
• Verfasst von: Jin, James [VerfasserIn]
• Verfasst von: Lang, Irene [VerfasserIn]
• Verfasst von: Veltkamp, Roland [VerfasserIn]
• Verfasst von: Dangas, George D. [VerfasserIn]
• Titel: Risk factors of ischemic stroke in patients with atrial fibrillation after transcatheter aortic valve implantation from the randomized ENVISAGE-TAVI AF trial
• Verf.angabe: Christian Hengstenberg,MD, Martin Unverdorben, MD, PhD,Helge Möllmann, MD, PhD, Nicolas M. Van Mieghem, MD, PhD, Holger Thiele, MD, Peter Nordbeck, MD, Tienush Rassaf, MD, Raul Moreno, MD, PhD, Roxana Mehran, MD, James Jin, PhD, Irene Lang, MD, Roland Veltkamp, MD, and George D. Dangas, MD, PhD
• E-Jahr: 2024
• Jahr: 15 September 2024
• Umfang: 7 S.
• Illustrationen: Illustrationen
• Fussnoten: Online verfügbar: 18. Juli 2024, Artikelversion: 10. August 2024 ; Gesehen am 10.07.2025
• Titel Quelle: Enthalten in: The American journal of cardiology
• Ort Quelle: Amsterdam [u.a.] : Elsevier, 1958
• Jahr Quelle: 2024
• Band/Heft Quelle: 227(2024) vom: Sept., Seite 98-104
• ISSN Quelle: 1879-1913
• DOI: doi:10.1016/j.amjcard.2024.07.019
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: atrial fibrillation
• Sach-SW: edoxaban
• Sach-SW: ischemic stroke
• Sach-SW: transcatheter aortic valve implantation
• K10plus-PPN: 1930147333

Abstract

In patients with prevalent or incident atrial fibrillation (AF) after successful transcatheter aortic valve implantation (TAVI) enrolled in the EdoxabaN Versus standard of care and theIr effectS on clinical outcomes in pAtients havinG undergonE Transcatheter Aortic Valve Implantation - in Atrial Fibrillation (ENVISAGE-TAVI AF) trial, the incidence of ischemic stroke (IS) and any stroke was numerically less in the edoxaban group than in the vitamin K antagonist (VKA) group. The present study aimed to identify risk factors associated with IS in an on-treatment subanalysis in patients from ENVISAGE-TAVI AF who received ≥1 dose of edoxaban or VKA. Baseline patient characteristics were compared in patients with and those without IS. Numerical variables were compared using a 1-way analysis of variance; categorical variables were compared using Fisher's exact test. Stepwise Cox regression determined patient characteristics associated with the first IS event. Of 1,377 patients, 41 (3.0%) experienced an IS, and 1,336 (97.0%) did not; baseline demographics and clinical characteristics were well balanced between groups. Most ISs occurred within 180 days of TAVI for edoxaban (57.9%) and VKA (68.2%). The rate of IS was 2.0/100 person-years for edoxaban versus 2.7/100 person-years for VKA. Independently associated with IS were history of systemic embolic events (hazard ratio 2.96, 95% confidence interval 1.26 to 7.00, p=0.01) and pre-TAVI use of VKAs (hazard ratio 2.17, 95% confidence interval 1.12 to 4.20, p=0.02). In conclusion, although the overall incidence of IS was small for patients with AF on edoxaban or VKA after successful TAVI, patients with a history of systemic embolic events or pre-TAVI use of VKAs may be at greater risk of IS after TAVI.