Incidence, Clinical Characteristics, and Impact of Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement

Vilalta, Victòria; Asmarats, Lluís; Ferreira‐Neto, Alfredo Nunes; Maes, Frédéric; Guimarães, Leonardo; Couture, Thomas; Paradis, Jean‐Michel; Mohammadi, Siamak; Dumont, Éric; Kalavrouziotis, Dimitri; DeLarochellière, Robert; Rodés‐Cabau, Josep

doi:10.1016/j.jcin.2018.09.001

Cited by 92 publications

(56 citation statements)

References 39 publications

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“…Second, we cannot exclude that the multiple comorbidities of our patients influenced the rate of invasive strategy in the management of ACS. In fact, about 30% of patients with an ACS in our TAVR population did not undergo coronary angiography, consistently with a recent report by Vilalta et al 16 Our low rate of CA access after TAVR should not be generalized to younger subjects with longer life expectancy. In fact, as TAVR indication shifts towards lower risk and possibly even to asymptomatic patients, 11,17,18 the need for CA and potentially PCI after TAVR is expected to increase, giving the progressive nature of CAD.…”

Section: Discussionsupporting

confidence: 90%

Incidence and feasibility of coronary access after transcatheter aortic valve replacement

Fovino

Scotti

Massussi

et al. 2020

Cathet Cardio Intervent

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Background Incidence of coronary access (CA) after transcatheter aortic valve replacement (TAVR) at long‐term follow‐up remains unknown. CA and percutaneous coronary intervention (PCI) after TAVR might present technical challenges, particularly with supra‐annular devices. Methods Patients undergoing CA after being treated with TAVR at our institution were included in the study. Coronary interventions for coronary obstruction during TAVR procedure were excluded. Incidence, feasibility and outcomes of CA after TAVR were analyzed. Results Out of 912 patients aged 80 ± 7 years treated with TAVR at our institution between 2007 and 2018, 48 (5.3%) underwent CA at a median follow up of 769 [363–1,471] days. Twenty‐one had received a SAPIEN XT, 15 a SAPIEN 3, 6 Corevalve, 2 Evolut Pro, 2 JenaValve, and 2 Lotus valve. PCI was indicated in 26 (54%) cases. Seventeen (35%) procedures were performed for acute coronary syndromes (ACS). Independent predictors of CA after TAVR were younger age, previous PCI, and CABG. CA of both vessels was feasible in all patients with an intra‐annular device, while the right coronary artery was not engaged in two patients with a supra‐annular valve. PCI was successful in all but one case. All‐cause mortality was similar between patients needing CA for ACS and those who had other clinical indications. Conclusions In this high‐risk AS population, incidence of CA after TAVR at long‐term follow‐up was rather low. CA and PCI were safe and successful in most cases, with a lower rate of selective CA for supra‐annular devices.

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Section: Discussionsupporting

confidence: 90%

Incidence and feasibility of coronary access after transcatheter aortic valve replacement

Fovino

Scotti

Massussi

et al. 2020

Cathet Cardio Intervent

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“…The exact prevalence and incidence of ACS among older adults (≥ 75 years of age) is not well known, as these patients have typically been underrepresented in ACS clinical trials 26 . In the only single‐center post TAVR ACS study, Vilalta et al reported an ACS incidence of 10% over a median follow‐up of 25 months 27 . Our findings showed a lower incidence of ACS; however, our study was limited to only in‐hospital ACS.…”

Section: Discussionmentioning

confidence: 62%

“…Our findings are similar to these results, with a preponderance of NSTE‐ACS (88.6%) events followed by STEMI (11.4%). Vilalta et al also reported a predominance of NSTE‐ACS (98.7%) events, with a low rate of STEMI (1.3%) 27 …”

Section: Discussionmentioning

confidence: 89%

“…The risk of ACS after TAVR was increased by a history of prior PCI, chronic blood loss anemia, hyperlipidemia, CKD, and weight loss. Vilalta et al reported prior PCI and use of a non‐transfemoral approach as independent predictors of ACS after TAVR 27 . Transapical access is now believed to be the least preferred access site for TAVR and is associated with a higher mortality compared to endovascular access 31 .…”

Section: Discussionmentioning

confidence: 99%

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Incidence, outcomes, and predictors of in‐hospital acute coronary syndrome following endovascular transcatheter aortic valve replacement in the United States

Nazir

Ahuja

Donato

et al. 2019

Cathet Cardio Intervent

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Background Incidence and outcomes of acute coronary syndrome (ACS) immediately following transcatheter aortic valve replacement (TAVR) remain largely unknown. Objectives This study sought to assess the incidence, clinical characteristics, and outcomes of ACS following TAVR. Methods We queried the National Readmission Database from January 2012 to September 2015 for TAVR admissions with and without ACS, creating a propensity‐matched cohort to compare outcomes. Results A total of 48,454 patients underwent TAVR, with 1,332 (2.75%) developing ACS. TAVR patients with ACS compared to those without ACS had a significantly higher incidence of acute kidney injury (24.7 vs. 19.2%; p = .001), ischemic stroke (3.7 vs. 2.3%; p = .04), vascular complications (8.6 vs. 5.8%; p = .008), cardiogenic shock (9.8 vs. 1.9%; p < .001), cardiac arrest (5.1 vs. 2.8%; p = .002), mechanical circulatory support (8.1 vs. 1.5%; p < .001), and in‐hospital mortality (9.6 vs. 3.4%; p < .001). Additionally, TAVR with ACS had longer lengths of stay (median 10 days vs. 6 days; p < .001) and hospital charges (median $23,200 vs. $19,000; p < .001). Positive predictors of ACS were history of PCI (odds ratio, 1.43; 95% CI: 1.25–1.63), hyperlipidemia (odds ratio, 1.20; 95% CI: 1.07–1.34), chronic blood loss anemia (odds ratio, 2.16; 95% CI: 1.54–3.03), chronic kidney disease (odds ratio, 1.17; 95% CI: 1.04–1.31), fluid and electrolyte disorders (odds ratio, 1.65; 95% CI: 1.47–1.85), and weight loss (odds ratio, 1.53; 95% CI: 1.22–1.91). Heart failure (34%) was the most common reason for readmission in the ACS cohort. Conclusion ACS after TAVR is uncommon but is associated with worse clinical outcomes and increased healthcare resource utilization.

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“…The rate of coronary artery disease (CAD) in TAVR patients ranges from 40 to 75% and as TAVR expands to low-risk patients, it is likely that these patients may require future coronary angiography and percutaneous coronary intervention (PCI) for either urgent or elective indications [ 107 ]. One study reported a 10% rate of acute coronary syndrome after TAVR with 47% of cases occurring within the first year [ 108 ]. A MDCT study of TAVR patients found that in 51% of cases, the ostia of one or both of the coronary arteries was blocked by the neo-commissure of the THV [ 109 ].…”

Section: Long-term Considerationsmentioning

confidence: 99%

Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR

et al. 2020

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Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we outline the critical role that SAVR will continue to play in the treatment of severe AS in the post-PARTNER 3/Evolut Low Risk era.

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Incidence, Clinical Characteristics, and Impact of Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement

Cited by 92 publications

References 39 publications

Incidence and feasibility of coronary access after transcatheter aortic valve replacement

Incidence and feasibility of coronary access after transcatheter aortic valve replacement

Incidence, outcomes, and predictors of in‐hospital acute coronary syndrome following endovascular transcatheter aortic valve replacement in the United States

Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR

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