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Asociación entre el reemplazo de la válvula aórtica transcatéter y el accidente cerebrovascular posprocedural

Chetan P Huded¹, E Murat Tuzcu¹, Amar Krishnaswamy¹

¹Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

|June 19, 2019

Resumen

Las tasas de accidentes cerebrovasculares después del reemplazo de la válvula aórtica transcatéter (TAVR) se mantuvieron estables entre 2011 y 2017. El accidente cerebrovascular posprocedural aumentó significativamente el riesgo de mortalidad a los 30 días, pero no se asoció con el tratamiento doble antiplaquetario o anticoagulante oral.

Área de la Ciencia:

Medicina cardiovascular
Cardiología intervencionista
Salud pública

Sus antecedentes:

La reducción del ictus post-procedural es crucial para mejorar la seguridad y los resultados del reemplazo de la válvula aórtica transcatéter (TAVR).
La comprensión de las tendencias del accidente cerebrovascular y los factores de riesgo después de TAVR es esencial para optimizar la atención al paciente.

Objetivo del estudio:

Evaluar las tendencias de ictus de 30 días después de TAVR en los EE.UU. durante sus primeros 5 años de uso.
Evaluar la asociación entre el accidente cerebrovascular post-procedural y la mortalidad a los 30 días.
Examinar el impacto de la terapia médica en el riesgo de accidente cerebrovascular durante 30 días.

Principales métodos:

Estudio de cohorte retrospectivo de 101.430 pacientes sometidos a TAVR desde noviembre de 2011 hasta mayo de 2017.
Análisis de las tasas de ictus y ataques isquémicos transitorios a los 30 días.
Para evaluar la mortalidad y las asociaciones terapéuticas se utilizaron modelos de riesgos proporcionales de Cox y el emparejamiento de la puntuación de propensión.

Principales resultados:

La tasa general de accidentes cerebrovasculares a los 30 días fue del 2,3%, con tasas que se mantuvieron estables durante todo el período del estudio (P=0, 22).
El accidente cerebrovascular dentro de los 30 días aumentó significativamente el riesgo de mortalidad (HR, 6.1; P<.001).
Ni el tratamiento antiplaquetario dual ni el tratamiento con anticoagulantes orales en el momento de la descarga se asociaron con una reducción del riesgo de accidente cerebrovascular a los 30 días.

Conclusiones:

La incidencia de accidentes cerebrovasculares a los 30 días después de la TAVR en los Estados Unidos se ha mantenido estable.
El ictus post-TAVR es un predictor independiente significativo de la mortalidad a los 30 días.
Las terapias médicas antitrombóticas actuales al alta no parecen influir en el riesgo de accidente cerebrovascular de 30 días.

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