Long-term cognitive outcomes following post-TAVR stroke: A propensity-matched analysis from the TriNetX network.

Area of Science:

• Cardiology
• Neurology
• Geriatrics

Background:

• Stroke is a known complication of transcatheter aortic valve replacement (TAVR).
• The long-term effects of post-TAVR stroke on cognitive function are not fully understood.
• This study examines the link between stroke after TAVR and subsequent cognitive decline.

Purpose of the Study:

• To investigate the association between stroke following TAVR and the development of vascular dementia and mild cognitive impairment.
• To identify predictors of cognitive decline in patients who have undergone TAVR.

Main Methods:

• Utilized the TriNetX Analytics Network (2010-2025) to identify 57,506 patients aged 65+ who had TAVR.
• Propensity score matching compared 2,662 patients with post-TAVR stroke to 2,662 patients without stroke.
• Assessed vascular dementia and mild cognitive impairment at 1, 3, and 5 years post-procedure.

Main Results:

• Vascular dementia rates were slightly higher in the stroke group at 1 year (3.1% vs 2.4%), but this difference diminished over time.
• Mild cognitive impairment rates were similar between groups at all time points.
• Independent predictors of cognitive decline included older age, anticoagulation use, and chronic kidney disease.

Conclusions:

• Post-TAVR stroke is associated with a modest, time-attenuating increase in vascular dementia risk.
• Cardiovascular risk factors appear more critical than stroke itself for long-term cognitive outcomes after TAVR.
• Optimizing management of modifiable risk factors is crucial for cognitive preservation post-TAVR.