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

Stroke represents a recognized complication of transcatheter aortic valve replacement (TAVR); its long-term impact on cognitive function remains incompletely characterized. We investigated the association between post-TAVR stroke and the subsequent development of vascular dementia and mild cognitive impairment.

Using the TriNetX Analytics Network (2010-2025), we identified 57,506 patients aged 65 years or older who underwent TAVR. After propensity score matching, we compared 2662 patients who experienced post-TAVR stroke with 2662 patients without stroke. Primary outcomes included the development of vascular dementia and mild cognitive impairment at 1, 3, and 5 years. Secondary analyses identified predictors of cognitive decline.

At 1 year, vascular dementia occurred in 3.1 % versus 2.4 % of patients with and without stroke, respectively (adjusted HR 1.29; 95 % CI 0.92-1.81; p = 0.137). This difference diminished at 3 years (4.5 % vs 4.1 %, adjusted HR 1.09; 95 % CI 0.84-1.41; p = 0.511) and 5 years (5.3 % vs 4.9 %, adjusted HR 1.09; 95 % CI 0.86-1.40; p = 0.456). Mild cognitive impairment rates remained similar across all groups at all time points. Independent predictors of cognitive decline included age (HR 1.08 per year; 95 % CI 1.05-1.10; p < 0.001), anticoagulation use (HR 1.63; 95 % CI 1.05-2.53; p = 0.029), and chronic kidney disease (HR 1.35; 95 % CI 1.01-1.80; p = 0.042).

Post-TAVR stroke is associated with a modestly increased risk of vascular dementia, particularly within the first year, but this difference attenuates over time. Traditional cardiovascular risk factors may be more influential than stroke itself in determining long-term cognitive trajectory.

Our findings suggest that while post-TAVR stroke impacts early cognitive outcomes, aggressive management of modifiable cardiovascular risk factors may be more crucial for long-term cognitive preservation. This has important implications for patient selection, procedural planning, and post-TAVR care optimization.