The effect of coronary artery disease defined by quantitative coronary angiography and SYNTAX score upon outcome after transcatheter aortic valve implantation (TAVI) using the Edwards bioprosthesis

Khawaja, Muhammed Zeeshan; Asrress, Kaleab; Haran, Hari; Arri, Saptal; Nadra, Imad; Bolter, Kirsty; Wilson, Karen M.; Clack, Lucy; Hancock, Jane; Young, Christopher; Bapat, Vinayak; Thomas, Martyn; Redwood, Simon

doi:10.4244/eijy14m05_09

Cited by 75 publications

(76 citation statements)

References 30 publications

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“…Previous analyses focusing solely on CAD complexity reported 1.6‐fold higher death and 2.4‐fold higher cardiac death rates post‐TAVI in patients with SYNTAX score >22 versus patients without CAD 10. Thereby, our findings advance previous evidence of an escalating risk of adverse TAVI outcomes across increasingly complex CAD10, 22 by indicating that detection of procedure‐related cTnT elevation substantially refines risk stratification in this setting.…”

Section: Discussionsupporting

confidence: 75%

Post‐Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation

Koskinas

Stortecky

Franzone

et al. 2016

JAHA

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BackgroundBiomarkers of myocardial injury increase frequently during transcatheter aortic valve implantation (TAVI). The impact of postprocedural cardiac troponin (cTn) elevation on short‐term outcomes remains controversial, and the association with long‐term prognosis is unknown.Methods and ResultsWe evaluated 577 consecutive patients with severe aortic stenosis treated with TAVI between 2007 and 2012. Myocardial injury, defined according to the Valve Academic Research Consortium (VARC)‐2 as post‐TAVI cardiac troponin T (cTnT) >15× the upper limit of normal, occurred in 338 patients (58.1%). In multivariate analyses, myocardial injury was associated with higher risk of all‐cause mortality at 30 days (adjusted hazard ratio [HR], 8.77; 95% CI, 2.07–37.12; P=0.003) and remained a significant predictor at 2 years (adjusted HR, 1.98; 95% CI, 1.36–2.88; P<0.001). Higher cTnT cutoffs did not add incremental predictive value compared with the VARC‐2–defined cutoff. Whereas myocardial injury occurred more frequently in patients with versus without coronary artery disease (CAD), the relative impact of cTnT elevation on 2‐year mortality did not differ between patients without CAD (adjusted HR, 2.59; 95% CI, 1.27–5.26; P=0.009) and those with CAD (adjusted HR, 1.71; 95% CI, 1.10–2.65; P=0.018; P for interaction=0.24). Mortality rates at 2 years were lowest in patients without CAD and no myocardial injury (11.6%) and highest in patients with complex CAD (SYNTAX score >22) and myocardial injury (41.1%).Conclusions VARC‐2–defined cTnT elevation emerged as a strong, independent predictor of 30‐day mortality and remained a modest, but significant, predictor throughout 2 years post‐TAVI. The prognostic value of cTnT elevation was modified by the presence and complexity of underlying CAD with highest mortality risk observed in patients combining SYNTAX score >22 and evidence of myocardial injury.

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Section: Discussionsupporting

confidence: 75%

Post‐Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation

Koskinas

Stortecky

Franzone

et al. 2016

JAHA

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“…Six studies (total of 3110 patients) were found to be eligible for inclusion after full text review. [12][13][14][22][23][24] All were observational studies, 2 multicenter and 4 single center studies. Follow-up period ranged from 0.7 to 3 years.…”

Section: Resultsmentioning

confidence: 99%

“…Because the study by Khawaja et al 22 did not report specifically on patients with reasonable ICR, but rather only on patients with no CAD, no CAD/reasonable ICR, and ICR, so it was not included in the analyses comparing reasonable ICR versus ICR and reasonable ICR versus no CAD. The study by Van Miegham et al 24 did not report on outcomes of patients with no CAD, so its results were included only in the analysis of reasonable ICR versus ICR.…”

Section: Resultsmentioning

confidence: 99%

Impact of Coronary Artery Revascularization Completeness on Outcomes of Patients With Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement

Witberg

Zusman

Codner

et al. 2018

Circ: Cardiovascular Interventions

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Background-Coronary artery disease (CAD) is highly prevalent in patients undergoing transcatheter aortic valve replacement.In the overall CAD population, complete revascularization or reasonable incomplete revascularization (ICR) is associated with improved outcomes; whether the same applies for the transcatheter aortic valve replacement population is still a matter of debate. Methods and Results-We conducted a systematic review and meta-analysis of studies that examined the prognostic effect of revascularization completeness in patients undergoing transcatheter aortic valve replacement using the residual SYNTAX score (Synergy Between PCI With Taxus and Cardiac Surgery) to separate between reasonable ICR and ICR (using the individual threshold used by each study). Six studies with a total of 3107 patients were included. The duration of follow-up ranged from 0.7 to 3 years. Overall, ICR was associated with an increased risk for mortality. This was true when comparing ICR patients to those with no CAD (odds ratio,

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“…A signifi cant correlation between SS and outcome after TAVI has been reported. 12,14) Higher SS is associated with worse prognosis following TAVI. An SS higher than 9 was identified as the optimal cut-off, with an independent association with mortality.…”

Section: Indication and Effectiveness Of Percutaneous Coronary Intervmentioning

confidence: 99%

“…Gasparetto et al 10) defined CAD as any previous coronary revascularization or present coronary stenosis of at least 50%, while Khawaja et al 14) defined significant CAD as coronary artery stenosis of ≥ 70% by quantitative coronary angiography. Patients with AS and coexisting CAD have been reported to be more frequently males, with higher prevalence of peripheral artery disease, previous myocardial infarction, previous PCI, previous CABG, and higher surgical risk.…”

Section: Coronary Artery Disease In Patients Undergoing Transcathetermentioning

confidence: 99%

Management of Coronary Artery Disease in Patients with Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

et al. 2015

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The effect of coronary artery disease defined by quantitative coronary angiography and SYNTAX score upon outcome after transcatheter aortic valve implantation (TAVI) using the Edwards bioprosthesis

Abstract: Significant CAD, as defined using "real-world" QCA margins, did not have a significant effect upon mortality after TAVI for severe aortic stenosis. However, higher-risk SYNTAX groups, including those with a score >9, had increased mortality.

Cited by 75 publications

References 30 publications

Post‐Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation

Post‐Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation

Impact of Coronary Artery Revascularization Completeness on Outcomes of Patients With Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement

Management of Coronary Artery Disease in Patients with Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

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