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, A. D'Onofrio, M. Agrifoglio, A. Chieffo, M. Cioni, Tommaso Regesta, G. Tarantini, Davide Gabbieri, Francesco Saia, Corrado Tamburino, Flavio Ribichini, Diego Cugola, M. Aiello, Francesca Sanna, A. Iadanza, E. Pompei, Miroslava Stolcova, Antonello Cappai, Alessandro MinatiMauro Cassese, G. L. Martinelli, Alessandro Agostinelli, G. Gerosa, Fiorenzo Gaita, M. M. 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
Publication statusPublished - 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

  • Aortic stenosis
  • Stroke
  • TAVI

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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, A.; Agrifoglio, M.; Chieffo, A.; Cioni, M.; Regesta, Tommaso; Tarantini, G.; Gabbieri, Davide; Saia, Francesco; Tamburino, Corrado; Ribichini, Flavio; Cugola, Diego; Aiello, M.; Sanna, Francesca; Iadanza, A.; Pompei, E.; Stolcova, Miroslava; Cappai, Antonello; Minati, Alessandro; Cassese, Mauro; Martinelli, G. L.; Agostinelli, Alessandro; Gerosa, G.; Gaita, Fiorenzo; Rinaldi, M. M.; Salizzoni, Stefano.

In: European Journal of Cardio-thoracic Surgery, Vol. 50, No. 5, 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, MM & 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.
Conrotto, Federico ; D'Ascenzo, Fabrizio ; D'Onofrio, A. ; Agrifoglio, M. ; Chieffo, A. ; Cioni, M. ; Regesta, Tommaso ; Tarantini, G. ; Gabbieri, Davide ; Saia, Francesco ; Tamburino, Corrado ; Ribichini, Flavio ; Cugola, Diego ; Aiello, M. ; Sanna, Francesca ; Iadanza, A. ; Pompei, E. ; Stolcova, Miroslava ; Cappai, Antonello ; Minati, Alessandro ; Cassese, Mauro ; Martinelli, G. L. ; Agostinelli, Alessandro ; Gerosa, G. ; Gaita, Fiorenzo ; Rinaldi, M. M. ; 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 = "Aortic stenosis, Stroke, TAVI",
author = "Federico Conrotto and Fabrizio D'Ascenzo and A. D'Onofrio and M. Agrifoglio and A. Chieffo and M. Cioni and Tommaso Regesta and G. Tarantini and Davide Gabbieri and Francesco Saia and Corrado Tamburino and Flavio Ribichini and Diego Cugola and M. Aiello and Francesca Sanna and A. Iadanza and E. Pompei and Miroslava Stolcova and Antonello Cappai and Alessandro Minati and Mauro Cassese and Martinelli, {G. L.} and Alessandro Agostinelli and G. Gerosa and Fiorenzo Gaita and Rinaldi, {M. M.} and Stefano Salizzoni",
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language = "English",
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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: an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis

AU - Conrotto, Federico

AU - D'Ascenzo, Fabrizio

AU - D'Onofrio, A.

AU - Agrifoglio, M.

AU - Chieffo, A.

AU - Cioni, M.

AU - Regesta, Tommaso

AU - Tarantini, G.

AU - Gabbieri, Davide

AU - Saia, Francesco

AU - Tamburino, Corrado

AU - Ribichini, Flavio

AU - Cugola, Diego

AU - Aiello, M.

AU - Sanna, Francesca

AU - Iadanza, A.

AU - Pompei, E.

AU - Stolcova, Miroslava

AU - Cappai, Antonello

AU - Minati, Alessandro

AU - Cassese, Mauro

AU - Martinelli, G. L.

AU - Agostinelli, Alessandro

AU - Gerosa, G.

AU - Gaita, Fiorenzo

AU - Rinaldi, M. M.

AU - Salizzoni, Stefano

N1 - LR: 20170208; CI: (c) The Author 2016; JID: 8804069; OTO: NOTNLM; 2015/10/12 [received]; 2016/04/09 [accepted]; ppublish M1 - Journal Article

PY - 2016

Y1 - 2016

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 - Aortic stenosis

KW - Stroke

KW - TAVI

M3 - Article

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 -