1. Risk Factors of Ischemic Stroke in Patients With Atrial Fibrillation After Transcatheter Aortic Valve Implantation from the Randomized ENVISAGE-TAVI AF Trial.
- Author
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Hengstenberg C, Unverdorben M, Möllmann H, Van Mieghem NM, Thiele H, Nordbeck P, Rassaf T, Moreno R, Mehran R, Jin J, Lang I, Veltkamp R, and Dangas GD
- Subjects
- Humans, Male, Female, Risk Factors, Aged, 80 and over, Incidence, Thiazoles therapeutic use, Aged, Postoperative Complications epidemiology, Vitamin K antagonists & inhibitors, Transcatheter Aortic Valve Replacement adverse effects, Atrial Fibrillation epidemiology, Atrial Fibrillation complications, Ischemic Stroke epidemiology, Ischemic Stroke prevention & control, Ischemic Stroke etiology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications, Factor Xa Inhibitors therapeutic use, Pyridines therapeutic use
- Abstract
In patients with prevalent or incident atrial fibrillation (AF) after successful transcatheter aortic valve implantation (TAVI) enrolled in the EdoxabaN Versus standard of care and theIr effectS on clinical outcomes in pAtients havinG undergonE Transcatheter Aortic Valve Implantation - in Atrial Fibrillation (ENVISAGE-TAVI AF) trial, the incidence of ischemic stroke (IS) and any stroke was numerically less in the edoxaban group than in the vitamin K antagonist (VKA) group. The present study aimed to identify risk factors associated with IS in an on-treatment subanalysis in patients from ENVISAGE-TAVI AF who received ≥1 dose of edoxaban or VKA. Baseline patient characteristics were compared in patients with and those without IS. Numerical variables were compared using a 1-way analysis of variance; categorical variables were compared using Fisher's exact test. Stepwise Cox regression determined patient characteristics associated with the first IS event. Of 1,377 patients, 41 (3.0%) experienced an IS, and 1,336 (97.0%) did not; baseline demographics and clinical characteristics were well balanced between groups. Most ISs occurred within 180 days of TAVI for edoxaban (57.9%) and VKA (68.2%). The rate of IS was 2.0/100 person-years for edoxaban versus 2.7/100 person-years for VKA. Independently associated with IS were history of systemic embolic events (hazard ratio 2.96, 95% confidence interval 1.26 to 7.00, p = 0.01) and pre-TAVI use of VKAs (hazard ratio 2.17, 95% confidence interval 1.12 to 4.20, p = 0.02). In conclusion, although the overall incidence of IS was small for patients with AF on edoxaban or VKA after successful TAVI, patients with a history of systemic embolic events or pre-TAVI use of VKAs may be at greater risk of IS after TAVI., Competing Interests: Declaration of competing interest Dr. Hengstenberg is a clinical proctor for Boston Scientific and Edwards Lifesciences and reports payment for speaker bureaus, support for attending meetings, and advisory board participation from Daiichi Sankyo in addition to institutional funding from Abbott Vascular, Amgen, Biosensors, Biotronik, Boehringer Ingelheim Boston Scientific, Daiichi Sankyo, Edwards Lifesciences, Ferrer, Medtronic, Novartis, Philips, Siemens, and Terumo. Dr. Unverdorben and Dr. Jin are employees of Daiichi Sankyo. Dr. Möllmann received personal fees from Abbott, AstraZeneca, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Daiichi Sankyo, Edwards Lifesciences, and Pfizer and support for attending meetings from Abbott, AstraZeneca, Boston Scientific, Daiichi Sankyo, Edwards Lifesciences, and Pfizer. Dr. Van Mieghem reports grants or contracts from Abbott, Abiomed, Boston Scientific, Daiichi Sankyo, Edwards Lifesciences, Medtronic, PulseCath BV, and Siemens. Dr. Thiele is the president of the German Society of Cardiology. Dr. Nordbeck reports speaker honoraria from Bayer, Boehringer Ingelheim, Daiichi Sankyo Europe GmbH, and Pfizer. Dr. Rassaf reports personal and other fees from AstraZeneca, Bayer, Bristol Myers Squibb, Daiichi Sankyo, and Novartis. Dr. Moreno reports personal fees from Abbott Vascular, Amgen, Biosensors, Boston Scientific, Daiichi Sankyo, Edwards Lifesciences, Ferrer, Medtronic, Philips, and Terumo. Dr. Mehran reports research grants to institution, support for attending meetings from Bayer and Daiichi Sankyo, and consulting fees from Daiichi Sankyo. Dr. Veltkamp reports grants or contracts from Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, and Medtronic and consulting or advisory board participation for AstraZeneca, Bristol Myers Squibb, Daiichi Sankyo, Javelin Ventures, and Portola Pharmaceuticals. Dr. Dangas reports research grants to institution, support for attending meetings from Bayer and Daiichi Sankyo, and consulting fees from Daiichi Sankyo. Dr. Lang has no competing interests to declare., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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