Author + information
- Amit Vora,
- Dadi (David) Dai,
- Roland Matsouaka,
- J. Kevin Harrison,
- G. Chad Hughes,
- Matthew Sherwood,
- Jonathan Piccini,
- David Cohen,
- David Holmes,
- Bhaskar Bhardwaj,
- Vinod Thourani,
- Eric Peterson and
- Sreekanth Vemulapalli
Background: Pre-procedure atrial fibrillation (AF) has been associated with adverse outcomes in patients undergoing TAVR, but the incidence of new-onset AF and related anticoagulant management and outcomes is unclear.
Methods: Using the STS/ACC TVT Registry linked with Medicare data we evaluated patients undergoing TAVR from 2011-2015 who developed post-procedure AF. Patients with AF prior to TAVR were excluded. Outcomes of interest included in-hospital mortality and stroke and all-cause mortality, stroke, and bleeding at 12 months.
Results: We identified 1138/13559 (8.4%) patients who developed new-onset AF. These patients were older, more likely women, had higher STS Risk Score, and more likely used transapical access. Only 28.9% of new AF patients were discharged on oral anticoagulation, though 49% were discharged on antiarrhythmic drug therapy. In-hospital mortality (7.8% vs. 3.4%, p<0.001) and stroke (4.7% vs. 2.0%, p<0.001) were higher among patients developing post-procedure AF compared with those who did not. At one year, rates of death, stroke, and bleeding were high among patients with post-TAVR AF (Figure) – differences that persisted after multivariable adjustment.
Conclusions: Post-TAVR AF is common, with low rates of anticoagulation at discharge, and is associated with increased risk of in-hospital and 1 year mortality and stroke. Given the high incidence of post-TAVR AF, additional studies are necessary to delineate the optimal management strategy in this high-risk population.
Saturday, March 18, 2017, 8:12 a.m.-8:22 a.m.
Session Title: Highlighted Original Research: Interventional Cardiology and the Year in Review
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 903-04
- 2017 American College of Cardiology Foundation