Atrial fibrillation in transfemoral transcatheter aortic valve implantation
Bibliographic record
Abstract
Abstract Background Atrial fibrillation (AF) is a frequent comorbidity in patients who undergo transcatheter aortic valve implantation (TAVI). In addition, new-onset AF can occur as a complication of TAVI. However, how AF affects clinical outcomes remains conflicting. Purpose Evaluate the impact of pre-existing and new-onset AF on outcomes after TAVI. Methods CENTER2 is an international patient-level pooled cohort that includes patients who underwent TAVI between 2007 and 2022. Clinical outcomes were compared in patients with and without pre-existing AF. Rates of new-onset atrial fibrillation at 30 days were evaluated in patients without pre-existing AF that survived the index hospitalisation, since new-onset AF shares a competing risk with death. Results A total of 23,320 patients (56.1% female; mean age 81.5±6.7 years) underwent transfemoral TAVI of whom 6579 (28.2%) had pre-existing atrial fibrillation. 1-year mortality was higher patients with AF than without (19.0% vs 14.2%, adjusted HR 1.39, 95%CI 1.26-1.53, p<0.001). Stroke rates were comparable at 30-day (2.4% vs 2.2%, p=0.47) and 1-year (7.2% vs 6.9%, p=0.57) follow-up. Only 76.8% (n=3140) of patients with AF were discharged on oral anticoagulation. Stroke rates in these patients did not differ significantly from those with AF and anticoagulation at discharge: at 30-day (2.5% vs 2.0%, p=0.33) and 1-year follow-up (6.5% vs 6.4%, p=0.98). Use of vitamin K antagonists was associated with higher bleeding rates compared to patients on direct oral anticoagulants (8.2% vs 4.6%, OR 1.83, 95%CI 1.35-2.49, p<0.001). There was no difference in 30-day stroke rates by anticoagulant type (1.7% vs 1.4%, p=0.54). However, 1-year stroke rates were lower in patients treated with vitamin K antagonists (5.5% vs 9.9%, OR 0.53, 95%CI 0.28-1.00, p=0.05). In patients without pre-existing AF who survived the index hospitalization, 681 (6.2%) had new-onset AF after TAVI. There were no differences in 1-year mortality (11.1% vs 8.6%, p=0.09) in patients with and without new-onset AF. Similarly, stroke incidence was comparable at 30 days (2.2% vs 2.1%, p=0.92) and 1-year (8.1% vs. 6.0%, p=0.16). Only 48.1% of patients with new-onset AF were discharged on anticoagulation, but there were no significant differences in rates of stroke compared with patients with new-onset AF and anticoagulation (1.8% vs 2.7%, p=0.50). However, new-onset AF was associated with higher rates of 30-day major bleeding (12.0% vs 6.7%, OR 1.90, 95%CI 1.49-2.43, p<0.001). Conclusions Pre-existing and new-onset AF in patients that undergo TAVI are not associated with higher risk for stroke.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".