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Optimized Screening of Coronary Artery Disease With Invasive Coronary Angiography and Ad Hoc Percutaneous Coronary

Marco Barbanti1, Denise Todaro2, Giuliano Costa2

  • 1From the Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., D.T., G.C., G.P., A.P., S.G., P.C., K.L.S., E.D.S., P.D., W.D., A.I., S.C., D.G., S.I., C.T., M.P., S.B., D.C., C.S., C.T.); and ETNA Foundation, Catania, Italy (C.T.). mbarbanti83@gmail.com.

Circulation. Cardiovascular Interventions
|August 4, 2017
PubMed

Insights

Screening for coronary artery disease (CAD) with invasive coronary angiography and percutaneous coronary intervention (PCI) during transcatheter aortic valve replacement (TAVR) is feasible. Performing PCI and TAVR in the same session showed similar outcomes to TAVR alone.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is a growing procedure for aortic stenosis.
  • Coronary artery disease (CAD) is common in patients undergoing TAVR and can impact outcomes.
  • Optimal screening and management strategies for CAD in this population are needed.

Purpose of the Study:

  • To describe an optimized approach for CAD screening and management in patients undergoing TAVR.
  • To evaluate the feasibility and safety of performing percutaneous coronary intervention (PCI) and TAVR in the same session.

Main Methods:

  • Prospective study of 604 patients undergoing CAD screening at the time of TAVR.
  • Invasive coronary angiography was performed, with treatment decisions based on coronary anatomy.
  • TAVR was performed same-session if PCI was uncomplicated; otherwise, it was postponed.

Main Results:

  • Severe CAD was identified in 22.5% of patients.
  • 8.8% underwent uncomplicated PCI, with TAVR postponed in only 0.3%.
  • Patients undergoing same-session TAVR and PCI had similar composite outcomes (death, stroke, myocardial infarction) compared to those without CAD or with untreated severe CAD (10.4% vs. 14.8% vs. 15.4%, P=0.765).

Conclusions:

  • Screening for CAD with invasive coronary angiography and ad hoc PCI during TAVR is feasible.
  • Performing PCI and TAVR in the same session is not associated with increased periprocedural risks.
  • Same-session PCI followed by TAVR yields similar outcomes to TAVR without concurrent PCI.
Abstract

Keywords:
acute kidney injuryaortic valve stenosiscoronary angiographycoronary artery diseasemyocardial infarctionstroke

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