TY - JOUR

T1 - Coronary artery disease, revascularization, and clinical outcomes in transcatheter aortic valve replacement

T2 - Real-world results from the East Denmark Heart Registry

AU - Millan-Iturbe, Oscar

AU - Sawaya, Fadi J

AU - Lønborg, Jacob

AU - Chow, Danny H F

AU - Bieliauskas, Gintautas

AU - Engstrøm, Thomas

AU - Søndergaard, Lars

AU - De Backer, Ole

N1 - © 2017 Wiley Periodicals, Inc.

PY - 2018

Y1 - 2018

N2 - Transcatheter aortic valve replacement (TAVR) has become an established therapeutic option for patients with symptomatic, severe aortic stenosis. The optimal treatment strategy for concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. This study aimed to describe the degree of CAD, revascularization strategies, and long-term clinical outcomes in a large-scale all-comers TAVR-population. Nine hundred and forty-four consecutive patients underwent TAVR. Obstructive CAD was reported in 224 patients (23.7%)-of these, 150 (66.9%) presented with one-vessel disease (1-VD), 51 (22.8%) with 2-VD, and 23 (10.3%) with 3-VD. Two-thirds underwent coronary revascularization before TAVR; half of those patients with 1-VD and only one-third of those with multivessel disease were completely revascularized. In general, borderline stenoses (50%-70%) were more frequently revascularized in proximal coronary segments than in more distal segments. Long-term survival rates by Kaplan-Meier analysis of the total TAVR population at 5 and 9 years were 64.7% and 54.1%, respectively. A diagnostic coronary angiography was performed in 16.5% of patients within 5 years after TAVR; only 4.8% underwent consequent percutaneous coronary intervention (PCI). There was no difference in survival and need for revascularization post-TAVR between those patients with or without obstructive CAD ± revascularization. Neither was there a survival difference between those with or without previous CABG and/or chronic total occlusion(s). In conclusion, CAD is prevalent in TAVR patients and pre-TAVR coronary revascularization is typically focused on treating proximal and high-grade stenosis. A selective pre-TAVR PCI strategy results in favorable clinical outcomes with very low rates of post-TAVR coronary revascularization.

AB - Transcatheter aortic valve replacement (TAVR) has become an established therapeutic option for patients with symptomatic, severe aortic stenosis. The optimal treatment strategy for concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. This study aimed to describe the degree of CAD, revascularization strategies, and long-term clinical outcomes in a large-scale all-comers TAVR-population. Nine hundred and forty-four consecutive patients underwent TAVR. Obstructive CAD was reported in 224 patients (23.7%)-of these, 150 (66.9%) presented with one-vessel disease (1-VD), 51 (22.8%) with 2-VD, and 23 (10.3%) with 3-VD. Two-thirds underwent coronary revascularization before TAVR; half of those patients with 1-VD and only one-third of those with multivessel disease were completely revascularized. In general, borderline stenoses (50%-70%) were more frequently revascularized in proximal coronary segments than in more distal segments. Long-term survival rates by Kaplan-Meier analysis of the total TAVR population at 5 and 9 years were 64.7% and 54.1%, respectively. A diagnostic coronary angiography was performed in 16.5% of patients within 5 years after TAVR; only 4.8% underwent consequent percutaneous coronary intervention (PCI). There was no difference in survival and need for revascularization post-TAVR between those patients with or without obstructive CAD ± revascularization. Neither was there a survival difference between those with or without previous CABG and/or chronic total occlusion(s). In conclusion, CAD is prevalent in TAVR patients and pre-TAVR coronary revascularization is typically focused on treating proximal and high-grade stenosis. A selective pre-TAVR PCI strategy results in favorable clinical outcomes with very low rates of post-TAVR coronary revascularization.

U2 - 10.1002/ccd.27440

DO - 10.1002/ccd.27440

M3 - Journal article

C2 - 29214718

VL - 92

SP - 818

EP - 826

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 4

ER -