The Effect of Coronary Lesion Complexity and Preprocedural Revascularization on 5-Year Outcomes After TAVR

Minten, Lennert; Wissels, Pauline; McCutcheon, Keir; Bennett, Johan; Adriaenssens, Tom; Desmet, Walter; Sinnaeve, Peter; Verbrugghe, Peter; Jacobs, Steven; Guler, Ipek; Dubois, Christophe

doi:10.1016/j.jcin.2022.06.019

Cited by 29 publications

(28 citation statements)

References 23 publications

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“…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 .…”

Section: Discussionsupporting

confidence: 90%

“…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 10‐12 . There are even two meta‐analyses with divergent results at this level 9,12 .…”

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: 90%

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Limitations in combining the results of these studies lie in differences in the definition of incomplete revascularization, follow-up times and comorbidities, and overall small patients numbers in the cohorts studied (Table 2, Ref. [16,38,[83][84][85][86][87][88][89][90][91][92][93][94]). To date, only one randomized clinical trial comparing TAVI with medical therapy vs TAVI with PCI in patients with severe AS and CAD has been performed [95].…”

Section: Revascularization In Tavimentioning

confidence: 99%

Unravelling the Fate of Coronary Artery Disease in Patients Undergoing Valve Replacement for Severe Aortic Valve Stenosis

Minten¹,

Bennett²,

McCutcheon³

et al. 2023

Rev. Cardiovasc. Med.

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Severe aortic valve stenosis is the most frequent valve pathology in the western world and approximately 50% of these patients have concomitant coronary artery disease (CAD). Revascularization of proximal obstructive CAD in patients undergoing surgical aortic valve replacement (SAVR) is common practice considered appropriate. However, the management of patients with CAD undergoing transcatheter aortic valve implantation (TAVI) is more controversial. Nevertheless, performing percutaneous coronary intervention (PCI) of significant (>70%) proximal coronary lesions is a widely adopted strategy, but robust supporting scientific evidence is missing. Some studies suggest that complex CAD with incomplete revascularization negatively impacts outcomes post-TAVI. As increasingly younger patients are undergoing TAVI, optimizing the long-term outcomes will become more important. Although PCI in TAVI patients is safe, no benefit on outcomes has been demonstrated, possibly due to an inadequate selection of prognostically important lesions for revascularization. A possible solution might be the use of coronary physiological indices, but these have their own limitations and more data is needed to support widespread adoption. In this review we provide an overview of current evidence on the outcomes after aortic valve replacement (AVR) and the evidence regarding revascularization in this population.

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“…In this perspective, Minten and colleagues [ 83 ] recently published the results of a large prospective single-center observational study, evaluating the interplay between CAD complexity, its management, and long-term outcomes after TAVR. This study, including 604 all-comers patients from 2008 to 2020, has shown that: (1) 346 patients presenting CAD had significantly worse all-cause death (55.1% vs. 67.9%; HR = 1.41; p = 0.022) and cardiovascular death (74.9% vs. 84.9%; HR = 1.62; p = 0.039) as compared with those without CAD at 5-year follow-up; a difference that was not significant at shorter term (1–3 years) of follow up; (2) the presence of complex CAD, defined as syntax score >22, was an independent predictor for cardiovascular death at 5 years after TAVR; and (3) neither pre-TAVR PCI nor completeness of revascularization seemed to reduce the increased risk for these adverse clinical outcomes.…”

Section: Concomitant Coronary Artery Disease In Patients Undergoing Tavrmentioning

confidence: 99%

Unmet Needs in TAVR: Conduction Disturbances and Management of Coronary Artery Disease

Auffret

Ridard

Salerno

et al. 2022

JCM

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Over the past two decades, transcatheter aortic valve replacement (TAVR) swiftly evolved from a disrupting technology towards mainstream therapy in the field of severe symptomatic aortic stenosis. A series of randomized evaluations established its role in treating severe aortic stenosis patients across all surgical risk categories, paving the way for an extension of its indications to younger low-risk patients with a longer life expectancy. Therefore, managing comorbidities and limiting procedural complications, which may affect long-term outcomes, is of paramount importance. Among those, new-onset conduction disturbances and concomitant coronary artery disease remain two of the most debated issues. In the present review, we will discuss the incidence, prognostic impact, and unmet needs of patients with post-TAVR new-onset conduction disturbances and the ongoing challenges posed by the management of concomitant coronary artery disease.

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The Effect of Coronary Lesion Complexity and Preprocedural Revascularization on 5-Year Outcomes After TAVR

Cited by 29 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

Unravelling the Fate of Coronary Artery Disease in Patients Undergoing Valve Replacement for Severe Aortic Valve Stenosis

Unmet Needs in TAVR: Conduction Disturbances and Management of Coronary Artery Disease

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