Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement.

Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement.

Li Jun; Patel SM; Nadeem F; Thakker P; Al-Kindi SG; Thomas R; Makani A; Hornick JM; Patel T; Lipinski J; Ichibori Y; Davis A; Markowitz AH; Bezerra HG; Simon DI; Costa MA; Kalra A; Attizzani GF

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

2019

2019-02-15

OBJECTIVES: This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). BACKGROUND: There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. METHODS: Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor). When feasible, SYNTAX scoring was performed for exploratory analysis. Analyses were performed using Cox proportional hazard models and Kaplan-Meier method. RESULTS: A total of 323 patients with active CAD were included. Adjusted outcomes showed that patients with IR Major had increased incidence of acute myocardial infarction (AMI) or revascularization compared with those in the CR cohort (HR 3.72, P = 0.048). No difference was noted in all-cause mortality or all-cause readmission rates. Exploratory secondary analysis with residual SYNTAX scores showed a significant interaction between disease burden and AMI/revascularization, as well as all-cause readmission. All-cause mortality remained unaffected based on residual SYNTAX scores. CONCLUSIONS: This is a retrospective single-center study reporting on pre-TAVR revascularization outcomes in patients with active CAD. In this analysis, we found that patients undergoing TAVR benefited from achieving complete revascularization to abate future incidence of AMI/revascularization. Despite this finding, all-cause mortality remained unaffected. Future efforts should focus on the role of functional assessment of the coronaries, as well as the long-term effects of complete revascularization in a larger patient cohort.

Female; Humans; Male; Aged; Retrospective Studies; Treatment Outcome; Risk Factors; Time Factors; Aged 80 and over; Patient Readmission; Risk Assessment; Cause of Death; Coronary Artery Disease/diagnostic imaging/mortality/therapy; AVD - aortic valve disease; CAD - coronary artery disease; Catheterization Peripheral/adverse effects/mortality; Femoral Artery; PCI - percutaneous coronary intervention (PCI); Percutaneous Coronary Intervention/adverse effects/mortality; percutaneous intervention; Transcatheter Aortic Valve Replacement/adverse effects/mortality; Aortic Valve Stenosis/diagnostic imaging/mortality/physiopathology/surgery; Aortic Valve/diagnostic imaging/physiopathology/surgery; Punctures

PMID: 30312990

© 2018 Wiley Periodicals, Inc.

journalArticle

545-552

3

93

1522-726X 1522-1946

NEOMED College of Medicine

Department of Internal Medicine

June2020SubmittedList

Cleveland Clinic Akron General Hospital