Stroke in patients with aortic stenosis: The simvastatin and ezetimibe in aortic stenosis study

Anders M. Greve, Morten Dalsgaard, Casper N. Bang, Kenneth Egstrup, Simon Ray, Kurt Boman, Anne B. Rossebø, Christa Gohlke-Baerwolf, Richard B. Devereux, Lars Køber, Kristian Wachtell

    Research output: Contribution to journalArticlepeer-review

    Abstract

    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
    Original languageEnglish
    Pages (from-to)1939-1946
    Number of pages7
    JournalStroke
    Volume45
    Issue number7
    DOIs
    Publication statusPublished - 2014

    Keywords

    • aortic valve stenosis
    • cardiac surgical procedures
    • risk factors
    • stroke

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