Open AccessImpact of coronary artery disease in patients undergoing transcatheter aortic valve replacement: Insights from the FRANCE‐2 registry
Author(s) -
Puymirat Etienne,
Didier Romain,
Eltchaninoff Hélène,
Lung Bernard,
Collet JeanPhilippe,
Himbert Dominique,
Durand Eric,
Leguerrier Alain,
Leprince Pascal,
Fajadet Jean,
Teiger Emmanuel,
Chevreul Karine,
Lièvre Michel,
Tchetché Didier,
Leclercq Florence,
Chassaing Stéphan,
Le Breton Hervé,
DonzeauGouge Patrick,
Lefèvre Thierry,
Carrié Didier,
Gillard Martine,
Blanchard Didier
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22830
Subject(s) - medicine , coronary artery disease , hazard ratio , cardiology , valve replacement , stenosis , population , confidence interval , surgery , environmental health
Background Coronary artery disease (CAD) is common in patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of CAD distribution before TAVR on short‐ and long‐term prognosis remains unclear. Hypothesis We hypothesized that the long‐term clinical impact differs according to CAD distribution in patients undergoing TAVR using the FRench Aortic National CoreValve and Edwards (FRANCE‐2) registry. Methods FRANCE‐2 is a national French registry including all consecutive TAVR performed between 2010 and 2012 in 34 centers. Three‐year mortality was assessed in relation to CAD status. CAD was defined as at least 1 coronary stenosis >50%. Results A total of 4201 patients were enrolled in the registry. For the present analysis, we excluded patients with a history of coronary artery bypass. CAD was reported in 1252 patients (30%). Half of the patients presented with coronary multivessel disease. CAD extent was associated with an increase in cardiovascular risk profile and in logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) (from 19.3% ± 12.8% to 21.9% ± 13.5%, P < 0.001). Mortality at 30 days and 3 years was 9% and 44%, respectively, in the overall population. In multivariate analyses, neither the presence nor the extent of CAD was associated with mortality at 3 years (presence of CAD, hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.78‐1.07). A significant lesion of the left anterior descending (LAD) was associated with higher 3‐year mortality (HR: 1.42; 95% CI: 1.10‐1.87). Conclusions CAD is not associated with decreased short‐ and long‐term survival in patients undergoing TAVR. The potential deleterious effect of LAD disease on long‐term survival and the need for revascularization before or at the time of TAVR should be validated in a randomized control trial.