Predictive ability of the CHADS2 and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation: an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis

Federico Conrotto, Fabrizio D'Ascenzo, Augusto D'Onofrio, Marco Agrifoglio, Alaide Chieffo, Micaela Cioni, Tommaso Regesta, Giuseppe Tarantini, Davide Gabbieri, Francesco Saia, Corrado Tamburino, Flavio Ribichini, Diego Cugola, Marco Aiello, Francesco Sanna, Alessandro Iadanza, Esmeralda Pompei, Miroslava Stolcova, Antioco Cappai, Alessandro MinatiMauro Cassese, Gian Luca Martinelli, Andrea Agostinelli, Gino Gerosa, Fiorenzo Gaita, Mauro Rinaldi, Stefano Salizzoni

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Stroke incidence after transcatheter aortic valve implantation (TAVI) still represents a concern. This multicentre study aimed at investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be used to predict perioperative stroke after TAVI.

METHODS: The Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a multicentre, prospective registry of patients undergoing balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis between 2007 and 2012. The primary end-point of this study was the 30-day stroke rate. Secondary safety end-points were all the major adverse events based on Valve Academic Research Consortium (VARC-2) criteria.

RESULTS: One thousand nine hundred and four patients were enrolled in the registry. Mean age was 81.6 ± 6.2 years and 1147 (60.2%) patients were female; mean CHADS2 and CHA2DS2-VASc scores were 2.2 ± 0.8 and 4.4 ± 1.1, respectively. Fifty-four (2.8%) patients had a stroke within 30 days. At multivariable logistic regression analysis, CHA2DS2-VASc (OR: 1.35, 95% CI: 1.03-1.78; P = 0.031) and previous cardiac surgery (OR: 1.96, 95% CI: 1.06-3.6; P = 0.033) but not CHADS2 (OR: 1.05, 95% CI: 0.76-1.44; P = 0.77) were found to be independent predictors of in-hospital stroke. A CHA2DS2-VASc score ≥5 was strongly related to the occurrence of in-hospital stroke (OR: 2.51, 95% CI: 1.38-4.57; P= 0.001). However, CHA2DS2-VASc score showed only poor accuracy for in-hospital stroke with a trend for better accuracy when compared with CHADS2 score (area under the curve: 0.61, 95% CI: 0.59-0.63 vs 0.51; 95% CI: 0.49-0.54, respectively, P = 0.092).

CONCLUSIONS: In TAVI patients, CHA2DS2-VASc provided a strong correlation for in-hospital stroke but with low accuracy. Dedicated scores to properly tailor procedures and preventive strategies are needed.

Original languageEnglish
Pages (from-to)867-873
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume50
Issue number5
DOIs
Publication statusPublished - Nov 2016

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Registries
Stroke
Thoracic Surgery
Multicenter Studies
Prostheses and Implants
Area Under Curve
Logistic Models
Regression Analysis
Safety
Transcatheter Aortic Valve Replacement
Incidence
Research

Keywords

  • Journal Article

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Predictive ability of the CHADS2 and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation : an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis. / Conrotto, Federico; D'Ascenzo, Fabrizio; D'Onofrio, Augusto; Agrifoglio, Marco; Chieffo, Alaide; Cioni, Micaela; Regesta, Tommaso; Tarantini, Giuseppe; Gabbieri, Davide; Saia, Francesco; Tamburino, Corrado; Ribichini, Flavio; Cugola, Diego; Aiello, Marco; Sanna, Francesco; Iadanza, Alessandro; Pompei, Esmeralda; Stolcova, Miroslava; Cappai, Antioco; Minati, Alessandro; Cassese, Mauro; Martinelli, Gian Luca; Agostinelli, Andrea; Gerosa, Gino; Gaita, Fiorenzo; Rinaldi, Mauro; Salizzoni, Stefano.

In: European Journal of Cardio-thoracic Surgery, Vol. 50, No. 5, 11.2016, p. 867-873.

Research output: Contribution to journalArticle

Conrotto, F, D'Ascenzo, F, D'Onofrio, A, Agrifoglio, M, Chieffo, A, Cioni, M, Regesta, T, Tarantini, G, Gabbieri, D, Saia, F, Tamburino, C, Ribichini, F, Cugola, D, Aiello, M, Sanna, F, Iadanza, A, Pompei, E, Stolcova, M, Cappai, A, Minati, A, Cassese, M, Martinelli, GL, Agostinelli, A, Gerosa, G, Gaita, F, Rinaldi, M & Salizzoni, S 2016, 'Predictive ability of the CHADS2 and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation: an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis', European Journal of Cardio-thoracic Surgery, vol. 50, no. 5, pp. 867-873. https://doi.org/10.1093/ejcts/ezw199
Conrotto, Federico ; D'Ascenzo, Fabrizio ; D'Onofrio, Augusto ; Agrifoglio, Marco ; Chieffo, Alaide ; Cioni, Micaela ; Regesta, Tommaso ; Tarantini, Giuseppe ; Gabbieri, Davide ; Saia, Francesco ; Tamburino, Corrado ; Ribichini, Flavio ; Cugola, Diego ; Aiello, Marco ; Sanna, Francesco ; Iadanza, Alessandro ; Pompei, Esmeralda ; Stolcova, Miroslava ; Cappai, Antioco ; Minati, Alessandro ; Cassese, Mauro ; Martinelli, Gian Luca ; Agostinelli, Andrea ; Gerosa, Gino ; Gaita, Fiorenzo ; Rinaldi, Mauro ; Salizzoni, Stefano. / Predictive ability of the CHADS2 and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation : an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis. In: European Journal of Cardio-thoracic Surgery. 2016 ; Vol. 50, No. 5. pp. 867-873.
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title = "Predictive ability of the CHADS2 and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation: an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis",
abstract = "OBJECTIVES: Stroke incidence after transcatheter aortic valve implantation (TAVI) still represents a concern. This multicentre study aimed at investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be used to predict perioperative stroke after TAVI.METHODS: The Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a multicentre, prospective registry of patients undergoing balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis between 2007 and 2012. The primary end-point of this study was the 30-day stroke rate. Secondary safety end-points were all the major adverse events based on Valve Academic Research Consortium (VARC-2) criteria.RESULTS: One thousand nine hundred and four patients were enrolled in the registry. Mean age was 81.6 ± 6.2 years and 1147 (60.2{\%}) patients were female; mean CHADS2 and CHA2DS2-VASc scores were 2.2 ± 0.8 and 4.4 ± 1.1, respectively. Fifty-four (2.8{\%}) patients had a stroke within 30 days. At multivariable logistic regression analysis, CHA2DS2-VASc (OR: 1.35, 95{\%} CI: 1.03-1.78; P = 0.031) and previous cardiac surgery (OR: 1.96, 95{\%} CI: 1.06-3.6; P = 0.033) but not CHADS2 (OR: 1.05, 95{\%} CI: 0.76-1.44; P = 0.77) were found to be independent predictors of in-hospital stroke. A CHA2DS2-VASc score ≥5 was strongly related to the occurrence of in-hospital stroke (OR: 2.51, 95{\%} CI: 1.38-4.57; P= 0.001). However, CHA2DS2-VASc score showed only poor accuracy for in-hospital stroke with a trend for better accuracy when compared with CHADS2 score (area under the curve: 0.61, 95{\%} CI: 0.59-0.63 vs 0.51; 95{\%} CI: 0.49-0.54, respectively, P = 0.092).CONCLUSIONS: In TAVI patients, CHA2DS2-VASc provided a strong correlation for in-hospital stroke but with low accuracy. Dedicated scores to properly tailor procedures and preventive strategies are needed.",
keywords = "Journal Article",
author = "Federico Conrotto and Fabrizio D'Ascenzo and Augusto D'Onofrio and Marco Agrifoglio and Alaide Chieffo and Micaela Cioni and Tommaso Regesta and Giuseppe Tarantini and Davide Gabbieri and Francesco Saia and Corrado Tamburino and Flavio Ribichini and Diego Cugola and Marco Aiello and Francesco Sanna and Alessandro Iadanza and Esmeralda Pompei and Miroslava Stolcova and Antioco Cappai and Alessandro Minati and Mauro Cassese and Martinelli, {Gian Luca} and Andrea Agostinelli and Gino Gerosa and Fiorenzo Gaita and Mauro Rinaldi and Stefano Salizzoni",
note = "{\circledC} The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.",
year = "2016",
month = "11",
doi = "10.1093/ejcts/ezw199",
language = "English",
volume = "50",
pages = "867--873",
journal = "European Journal of Cardio-thoracic Surgery",
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publisher = "European Association for Cardio-Thoracic Surgery",
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TY - JOUR

T1 - Predictive ability of the CHADS2 and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation

T2 - an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis

AU - Conrotto, Federico

AU - D'Ascenzo, Fabrizio

AU - D'Onofrio, Augusto

AU - Agrifoglio, Marco

AU - Chieffo, Alaide

AU - Cioni, Micaela

AU - Regesta, Tommaso

AU - Tarantini, Giuseppe

AU - Gabbieri, Davide

AU - Saia, Francesco

AU - Tamburino, Corrado

AU - Ribichini, Flavio

AU - Cugola, Diego

AU - Aiello, Marco

AU - Sanna, Francesco

AU - Iadanza, Alessandro

AU - Pompei, Esmeralda

AU - Stolcova, Miroslava

AU - Cappai, Antioco

AU - Minati, Alessandro

AU - Cassese, Mauro

AU - Martinelli, Gian Luca

AU - Agostinelli, Andrea

AU - Gerosa, Gino

AU - Gaita, Fiorenzo

AU - Rinaldi, Mauro

AU - Salizzoni, Stefano

N1 - © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

PY - 2016/11

Y1 - 2016/11

N2 - OBJECTIVES: Stroke incidence after transcatheter aortic valve implantation (TAVI) still represents a concern. This multicentre study aimed at investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be used to predict perioperative stroke after TAVI.METHODS: The Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a multicentre, prospective registry of patients undergoing balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis between 2007 and 2012. The primary end-point of this study was the 30-day stroke rate. Secondary safety end-points were all the major adverse events based on Valve Academic Research Consortium (VARC-2) criteria.RESULTS: One thousand nine hundred and four patients were enrolled in the registry. Mean age was 81.6 ± 6.2 years and 1147 (60.2%) patients were female; mean CHADS2 and CHA2DS2-VASc scores were 2.2 ± 0.8 and 4.4 ± 1.1, respectively. Fifty-four (2.8%) patients had a stroke within 30 days. At multivariable logistic regression analysis, CHA2DS2-VASc (OR: 1.35, 95% CI: 1.03-1.78; P = 0.031) and previous cardiac surgery (OR: 1.96, 95% CI: 1.06-3.6; P = 0.033) but not CHADS2 (OR: 1.05, 95% CI: 0.76-1.44; P = 0.77) were found to be independent predictors of in-hospital stroke. A CHA2DS2-VASc score ≥5 was strongly related to the occurrence of in-hospital stroke (OR: 2.51, 95% CI: 1.38-4.57; P= 0.001). However, CHA2DS2-VASc score showed only poor accuracy for in-hospital stroke with a trend for better accuracy when compared with CHADS2 score (area under the curve: 0.61, 95% CI: 0.59-0.63 vs 0.51; 95% CI: 0.49-0.54, respectively, P = 0.092).CONCLUSIONS: In TAVI patients, CHA2DS2-VASc provided a strong correlation for in-hospital stroke but with low accuracy. Dedicated scores to properly tailor procedures and preventive strategies are needed.

AB - OBJECTIVES: Stroke incidence after transcatheter aortic valve implantation (TAVI) still represents a concern. This multicentre study aimed at investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be used to predict perioperative stroke after TAVI.METHODS: The Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a multicentre, prospective registry of patients undergoing balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis between 2007 and 2012. The primary end-point of this study was the 30-day stroke rate. Secondary safety end-points were all the major adverse events based on Valve Academic Research Consortium (VARC-2) criteria.RESULTS: One thousand nine hundred and four patients were enrolled in the registry. Mean age was 81.6 ± 6.2 years and 1147 (60.2%) patients were female; mean CHADS2 and CHA2DS2-VASc scores were 2.2 ± 0.8 and 4.4 ± 1.1, respectively. Fifty-four (2.8%) patients had a stroke within 30 days. At multivariable logistic regression analysis, CHA2DS2-VASc (OR: 1.35, 95% CI: 1.03-1.78; P = 0.031) and previous cardiac surgery (OR: 1.96, 95% CI: 1.06-3.6; P = 0.033) but not CHADS2 (OR: 1.05, 95% CI: 0.76-1.44; P = 0.77) were found to be independent predictors of in-hospital stroke. A CHA2DS2-VASc score ≥5 was strongly related to the occurrence of in-hospital stroke (OR: 2.51, 95% CI: 1.38-4.57; P= 0.001). However, CHA2DS2-VASc score showed only poor accuracy for in-hospital stroke with a trend for better accuracy when compared with CHADS2 score (area under the curve: 0.61, 95% CI: 0.59-0.63 vs 0.51; 95% CI: 0.49-0.54, respectively, P = 0.092).CONCLUSIONS: In TAVI patients, CHA2DS2-VASc provided a strong correlation for in-hospital stroke but with low accuracy. Dedicated scores to properly tailor procedures and preventive strategies are needed.

KW - Journal Article

U2 - 10.1093/ejcts/ezw199

DO - 10.1093/ejcts/ezw199

M3 - Article

C2 - 27354254

VL - 50

SP - 867

EP - 873

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 5

ER -