Impact of Coronary Revascularization in Patients Who Underwent Transcatheter Aortic Valve Implantation

Otero, Diego López; Ávila-Carrillo, Alejandro; González‐Ferreiro, Rocío; Menendez, A Cid; Álvarez, Diego; Rodríguez, Leyre Álvarez; Muiños, Pablo Antúnez; Álvarez, Belén Cid; Pena, Xoan Carlos Sanmartín; Pérez, Fernando Gómez; Diéguez, Alfredo Redondo; Cruz-González, Ignacio; Trillo-Nouche, Ramiro; González-Juanatey, José Ramón

doi:10.1016/j.amjcard.2018.12.007

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…In our study, neither the presence nor the extent of CAD, nor the degree of revascularization, was associated with a prognostic impact in patients undergoing TAVI at 5‐year follow‐up. This is consistent with the findings of other similar studies performed in our setting, although with a shorter clinical follow‐up 6 …”

Section: Discussionsupporting

confidence: 93%

“…14 On the other hand and in line with the results obtained in our analysis, other observational studies previously mentioned in the present article point out that PCI does not imply any benefit in terms of overall mortality in this patient profile. 6,8 In a meta-analysis published in 2019 with more than 5500 patients, percutaneous revascularization was not associated with additional prognostic benefit in patients with CAD undergoing TAVI. 11 The only available randomized clinical trial in patients with severe aortic stenosis and CAD comparing the strategy of PCI and TAVI versus TAVI alone (ACTIVA-TION trial) showed no statistically significant difference in the combined event of death or rehospitalization between both strategies, with a higher rate of bleeding among patients who underwent PCI, 15 although the study involved a small number of patients (235 patients), with a short clinical follow-up (1 year) and with a small amount of CAD (70% of patients had single-vessel disease).…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with the findings of other similar studies performed in our setting, although with a shorter clinical follow-up. 6 With respect to the prognostic implications of CAD in patients undergoing TAVI, the clinical evidence available to date is controversial. In the scientific literature published to date, there are some observational studies that show that CAD implies a worse prognosis, 7,8 others in which there is no such prognostic effect 9,10 and others in which prognosis is only related to the severity of CAD.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic impact of coronary lesions and its revascularization in a 5‐year follow‐up after the TAVI procedure

Vázquez

López

Guzman

et al. 2023

Cathet Cardio Intervent

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BackgroundCoronary artery disease (CAD) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). However, its prognostic significance and its management remains controversial.AimsThis study sought to determine whether the presence of CAD, its complexity, and angiography‐guided percutaneous coronary intervention (PCI) are associated with outcomes after TAVI.MethodsAll patients undergoing TAVI at a tertiary referral center between 2008 and 2018 were included in a prospective observational study. Baseline SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score (SS) and a residual SS after PCI were calculated. The endpoints on the 5 year follow‐up were all‐cause mortality and a composite of mayor cardiovascular adverse events (MACE).ResultsIn 379 patients, the presence of CAD and its complexity were not significantly associated with worse 5‐year survival after TAVI, with a mortality for SS0 of 45%; for SS 1–22 of 36.5% (HR 0.77; 95% CI 0.53–1.11, p = 0.15) and for SS > 22 of 42.1% (HR 1.24; 95% CI 0.59–2.63, p = 0.57). Regarding the combined event of MACE, there were also no statistically significant differences between patients with CAD and without CAD (56.8% in patients without CAD and 54.9% in patients with CAD; HR 1.06; 95% CI 0.79–1.43, p = 0.7). Angiography‐guided PCI or completeness of revascularization was not associated with different outcomes.ConclusionsIn the present analysis, neither the presence nor the extent of CAD, nor the degree of revascularization, was associated with a prognostic impact in patients undergoing TAVI at 5‐year follow‐up.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prognostic impact of coronary lesions and its revascularization in a 5‐year follow‐up after the TAVI procedure

Vázquez

López

Guzman

et al. 2023

Cathet Cardio Intervent

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“…[16][17][18] To date, the benefit of coronary revascularization in the setting of TAVI has been mainly investigated in small, nonrandomized studies, and results are contradictory. 5,6,8,10 The ACTIVATION study is the only randomized clinical trial that explored the benefit of PCI in patients undergoing TAVI with significant CAD. 14 The trial showed similar rates of the primary composite end point of allcause death and rehospitalization at 1 year in patients receiving PCI or not (41.5% versus 44.0%).…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Nevertheless, indication for treatment of significant CAD in TAVI setting still remains a matter of debate, due to the marked inconsistency of the available evidence, which are mainly based on nonrandomized data. 2,[5][6][7][8][9][10][11][12] In fact, whether performing PCI and achieving complete revascularization in patients undergoing TAVI would offer a clinical benefit in patients with significant CAD remains unclear. 13 The randomized, noninferiority ACTIVATION trial (Percutaneous Coronary Intervention Prior to Transcatheter Aortic Valve Implantation) showed that rates of death and rehospitalization at 1 year were similar between PCI and no PCI prior to TAVI.…”

mentioning

confidence: 99%

Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation

Costa

Pilgrim

Santos

et al. 2022

Circ: Cardiovascular Interventions

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Background: The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. Methods: The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. Results: Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio‚ 0.88 [95% CI, 0.66–1.18]; P =0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio‚ 0.97 [95% CI, 0.76–1.24]; P =0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). Conclusions: The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.

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TAVI et revascularisation coronaire

Combaret

Bouchant

Motreff

2019

Annales de Cardiologie et d'Angéiologie

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Impact of Coronary Revascularization in Patients Who Underwent Transcatheter Aortic Valve Implantation

Cited by 14 publications

References 23 publications

Prognostic impact of coronary lesions and its revascularization in a 5‐year follow‐up after the TAVI procedure

Prognostic impact of coronary lesions and its revascularization in a 5‐year follow‐up after the TAVI procedure

Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation

TAVI et revascularisation coronaire

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