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Coronary artery disease, revascularization, and clinical outcomes in transcatheter aortic valve replacement: Real‐world results from the East Denmark Heart Registry
Author(s) -
MillanIturbe Oscar,
Sawaya Fadi J.,
Lønborg Jacob,
Chow Danny H.F.,
Bieliauskas Gintautas,
Engstrøm Thomas,
Søndergaard Lars,
De Backer Ole
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27440
Subject(s) - medicine , revascularization , cardiology , coronary artery disease , valve replacement , percutaneous coronary intervention , stenosis , population , surgery , myocardial infarction , environmental health
Abstract 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.