TY - JOUR
T1 - Stroke in Patients With Aortic Stenosis
T2 - The Simvastatin and Ezetimibe in Aortic Stenosis Study
AU - Greve, Anders Møller
AU - Dalsgaard, Morten
AU - Bang, Casper N
AU - Egstrup, Kenneth
AU - Ray, Simon
AU - Boman, Kurt
AU - Rossebø, Anne B
AU - Gohlke-Baerwolf, Christa
AU - Devereux, Richard B
AU - Køber, Lars
AU - Wachtell, Kristian
N1 - © 2014 American Heart Association, Inc.
PY - 2014/7
Y1 - 2014/7
N2 - BACKGROUND AND PURPOSE - : There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting influenced the predicted outcomes. METHODS - : Patients with mild-to-moderate aortic stenosis enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Diabetes mellitus, known atherosclerotic disease, and oral anticoagulation were exclusion criteria. Ischemic stroke was the primary end point, and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex (CHA 2DS2-VASc) scores. RESULTS - : One thousand five hundred nine patients were followed for 4.3±0.8 years (6529 patient-years). Rates of stroke were 5.6 versus 21.8 per 1000 patient-years pre- and post-AVR; 429 (28%) underwent AVR and 139 (9%) died. Atrial fibrillation (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.1-6.6), CHA2DS2-VASc score (HR 1.4 per unit; 95% CI, 1.1-1.8), diastolic blood pressure (HR, 1.4 per 10 mm Hg; 95% CI, 1.1-1.8), and AVR with concomitant coronary artery bypass grafting (HR, 3.2; 95% CI, 1.4-7.2, all P≤0.026) were independently associated with stroke. Incident stroke predicted death (HR, 8.1; 95% CI, 4.7-14.0; P<0.001). CONCLUSIONS - : In patients with aortic stenosis not prescribed oral anticoagulation, atrial fibrillation, AVR with concomitant coronary artery bypass grafting, and CHA2DS2-VASc score were the major predictors of stroke. Incident stroke was strongly associated with mortality.
AB - BACKGROUND AND PURPOSE - : There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting influenced the predicted outcomes. METHODS - : Patients with mild-to-moderate aortic stenosis enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Diabetes mellitus, known atherosclerotic disease, and oral anticoagulation were exclusion criteria. Ischemic stroke was the primary end point, and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex (CHA 2DS2-VASc) scores. RESULTS - : One thousand five hundred nine patients were followed for 4.3±0.8 years (6529 patient-years). Rates of stroke were 5.6 versus 21.8 per 1000 patient-years pre- and post-AVR; 429 (28%) underwent AVR and 139 (9%) died. Atrial fibrillation (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.1-6.6), CHA2DS2-VASc score (HR 1.4 per unit; 95% CI, 1.1-1.8), diastolic blood pressure (HR, 1.4 per 10 mm Hg; 95% CI, 1.1-1.8), and AVR with concomitant coronary artery bypass grafting (HR, 3.2; 95% CI, 1.4-7.2, all P≤0.026) were independently associated with stroke. Incident stroke predicted death (HR, 8.1; 95% CI, 4.7-14.0; P<0.001). CONCLUSIONS - : In patients with aortic stenosis not prescribed oral anticoagulation, atrial fibrillation, AVR with concomitant coronary artery bypass grafting, and CHA2DS2-VASc score were the major predictors of stroke. Incident stroke was strongly associated with mortality.
KW - Aged
KW - Aged, 80 and over
KW - Anticholesteremic Agents
KW - Aortic Valve Stenosis
KW - Azetidines
KW - Comorbidity
KW - Coronary Artery Bypass
KW - Female
KW - Heart Valve Prosthesis Implantation
KW - Humans
KW - Ischemic Attack, Transient
KW - Male
KW - Middle Aged
KW - Multicenter Studies as Topic
KW - Outcome Assessment (Health Care)
KW - Randomized Controlled Trials as Topic
KW - Severity of Illness Index
KW - Simvastatin
KW - Stroke
U2 - 10.1161/STROKEAHA.114.005296
DO - 10.1161/STROKEAHA.114.005296
M3 - Journal article
C2 - 24903982
SN - 0039-2499
VL - 45
SP - 1939
EP - 1946
JO - Stroke
JF - Stroke
IS - 7
ER -
