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Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement
Author(s) -
Li Jun,
Patel Sandeep M.,
Nadeem Fahd,
Thakker Prashanth,
AlKindi Sadeer,
Thomas Rahul,
Makani Amber,
Hornick John M.,
Patel Toral,
Lipinski Jerry,
Ichibori Yasuhiro,
Davis Angela,
Markowitz Alan H.,
Bezerra Hiram G.,
Simon Daniel I.,
Costa Marco A.,
Kalra Ankur,
Attizzani Guilherme F.
Publication year - 2019
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.27894
Subject(s) - medicine , revascularization , cardiology , coronary artery disease , hazard ratio , myocardial infarction , retrospective cohort study , valve replacement , proportional hazards model , incidence (geometry) , aortic valve replacement , cohort , surgery , stenosis , confidence interval , physics , optics
Abstract 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.