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Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set

BACKGROUND: Studies on stroke risk following cardiac procedures addressed only perioperative and long‐term risk following limited higher‐risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardia...

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Autores principales: Stein, Laura, Thaler, Alison, Liang, John W., Tuhrim, Stanley, Dhamoon, Amit S., Dhamoon, Mandip S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779011/
https://www.ncbi.nlm.nih.gov/pubmed/29197827
http://dx.doi.org/10.1161/JAHA.117.006900
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author Stein, Laura
Thaler, Alison
Liang, John W.
Tuhrim, Stanley
Dhamoon, Amit S.
Dhamoon, Mandip S.
author_facet Stein, Laura
Thaler, Alison
Liang, John W.
Tuhrim, Stanley
Dhamoon, Amit S.
Dhamoon, Mandip S.
author_sort Stein, Laura
collection PubMed
description BACKGROUND: Studies on stroke risk following cardiac procedures addressed only perioperative and long‐term risk following limited higher‐risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardiac procedures compared with common noncardiac surgeries and medical admissions. METHODS AND RESULTS: The Nationwide Readmissions Database contains readmission data for 49% of US admissions in 2013. We compared age‐adjusted stroke readmission rates up to 90 days postdischarge. We used Cox regression to calculate hazard ratios, up to 1 year, of stroke risk comparing transcatheter aortic valve replacement versus surgical aortic valve replacement and coronary artery bypass graft versus percutaneous coronary intervention. Procedures and diagnoses were identified by International Classification of Disease, Ninth Revision, Clinical Modification codes. After cardiac procedures, 90‐day ischemic stroke readmission rate was highest after transcatheter aortic valve replacement (2.05%); 90‐day hemorrhagic stroke rate was highest after left ventricular assist device placement (0.09%). The hazard ratio for ischemic stroke after transcatheter aortic valve replacement, compared with surgical aortic valve replacement, in fully adjusted Cox models was 1.86 (95% confidence interval, 1.12–3.08; P=0.016) and 6.17 (95% confidence interval, 1.97–19.33; P=0.0018) for hemorrhagic stroke. There was no difference between coronary artery bypass graft and percutaneous coronary intervention. CONCLUSIONS: We demonstrated elevated readmission rates for ischemic and hemorrhagic stroke in the intermediate 30‐, 60‐, and 90‐day risk periods following common cardiac procedures. Furthermore, we found an elevated risk of stroke after transcatheter aortic valve replacement compared with surgical aortic valve replacement up to 1 year.
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spelling pubmed-57790112018-01-26 Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set Stein, Laura Thaler, Alison Liang, John W. Tuhrim, Stanley Dhamoon, Amit S. Dhamoon, Mandip S. J Am Heart Assoc Original Research BACKGROUND: Studies on stroke risk following cardiac procedures addressed only perioperative and long‐term risk following limited higher‐risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardiac procedures compared with common noncardiac surgeries and medical admissions. METHODS AND RESULTS: The Nationwide Readmissions Database contains readmission data for 49% of US admissions in 2013. We compared age‐adjusted stroke readmission rates up to 90 days postdischarge. We used Cox regression to calculate hazard ratios, up to 1 year, of stroke risk comparing transcatheter aortic valve replacement versus surgical aortic valve replacement and coronary artery bypass graft versus percutaneous coronary intervention. Procedures and diagnoses were identified by International Classification of Disease, Ninth Revision, Clinical Modification codes. After cardiac procedures, 90‐day ischemic stroke readmission rate was highest after transcatheter aortic valve replacement (2.05%); 90‐day hemorrhagic stroke rate was highest after left ventricular assist device placement (0.09%). The hazard ratio for ischemic stroke after transcatheter aortic valve replacement, compared with surgical aortic valve replacement, in fully adjusted Cox models was 1.86 (95% confidence interval, 1.12–3.08; P=0.016) and 6.17 (95% confidence interval, 1.97–19.33; P=0.0018) for hemorrhagic stroke. There was no difference between coronary artery bypass graft and percutaneous coronary intervention. CONCLUSIONS: We demonstrated elevated readmission rates for ischemic and hemorrhagic stroke in the intermediate 30‐, 60‐, and 90‐day risk periods following common cardiac procedures. Furthermore, we found an elevated risk of stroke after transcatheter aortic valve replacement compared with surgical aortic valve replacement up to 1 year. John Wiley and Sons Inc. 2017-12-02 /pmc/articles/PMC5779011/ /pubmed/29197827 http://dx.doi.org/10.1161/JAHA.117.006900 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Stein, Laura
Thaler, Alison
Liang, John W.
Tuhrim, Stanley
Dhamoon, Amit S.
Dhamoon, Mandip S.
Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set
title Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set
title_full Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set
title_fullStr Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set
title_full_unstemmed Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set
title_short Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set
title_sort intermediate‐term risk of stroke following cardiac procedures in a nationally representative data set
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779011/
https://www.ncbi.nlm.nih.gov/pubmed/29197827
http://dx.doi.org/10.1161/JAHA.117.006900
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