Stroke in Patients With Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study

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 -