Abstract
Purpose :
Transcatheter procedures are increasingly used to treat a variety of cardiac conditions, but the risk of clinically significant peri-procedural retinal artery occlusion (RAO) has not been well characterized. In this study, we use the National Inpatient Sample (NIS) to determine the risk of peri-procedural RAO in transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI).
Methods :
Patients who underwent TAVR and PCI were identified in years 2006 to 2017 of the NIS. NIS is a large, nationally representative sample of hospitalizations, which allows for characterization of rare events like RAO. Rates of transient, branch, central, and peripheral RAO were computed based on non-primary ICD-9/10 diagnosis codes assigned at discharge. The rate of peri-procedural stroke was also calculated for these procedures as a positive control, as these rates are well-characterized in the literature. Because NIS lacks present-on-admission flags to exclude pre-existing RAO, we report the rate of RAO as an upper bound of the true periprocedural rate. Sample weights published by the NIS were used to produce nationally representative estimates. To determine the significance of differences between rates, p-values were calculated by z-test.
Results :
161,829 patients underwent TAVR and 6,970,152 patients underwent PCI. The rate of all RAO in patients undergoing TAVR was 6.4/10,000 (95% CI 3.7 to 9.2), and non-transient RAO was 4.3/10,000 (95% CI 2.1 to 6.6). In patients undergoing PCI, the rate of all RAO was 2.0/10,000 (95% CI 1.7 to 2.2), and non-transient RAO was 6.0/100,000 (95% CI 4.9 to 7.6). The rate of stroke in patients undergoing TAVR and PCI was 2.1% (95% CI 1.9 to 2.2%) and 0.58% (95% CI 0.56 to 0.60%), respectively, consistent with previously published rates. The rate of peri-procedural RAO was higher in TAVR than in PCI (p-value < 0.001). The rate of peri-procedural stroke was higher than peri-procedural RAO in both TAVR and PCI (p-values < 0.001).
Conclusions :
Peri-procedural RAO as a complication of TAVR and PCI is rare, with true rates likely to be less than 9/10,000 and 2/100,000, respectively. Peri-procedural RAO is significantly more common in TAVR than in PCI and less common than stroke in both procedures.
This is a 2021 ARVO Annual Meeting abstract.