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CAD strategy in the TAVR era

Laura J Davidson1, Charles J Davidson1

  • 1Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 17, 2019
PubMed

Insights

Optimal revascularization for coronary artery disease (CAD) in TAVR patients is unclear. Complete revascularization reduces heart attack risk but doesn't improve survival, suggesting a need for better strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Transcatheter Aortic Valve Replacement

Background:

  • The optimal revascularization strategy for patients undergoing Transcatheter Aortic Valve Replacement (TAVR) with Coronary Artery Disease (CAD) remains undefined.
  • Current decision-making for Percutaneous Coronary Intervention (PCI) in TAVR patients relies heavily on operator preference or anatomical scoring systems like the SYNTAX score.

Discussion:

  • Complete revascularization in the TAVR population does not confer benefits in short or long-term mortality.
  • However, complete revascularization is linked to a reduction in acute myocardial infarction and repeat revascularization procedures compared to incomplete revascularization.

Key Insights:

  • Complete revascularization in TAVR patients does not improve mortality outcomes.
  • A significant finding is the association of complete revascularization with reduced rates of acute myocardial infarction and repeat revascularization.

Outlook:

  • Future research should focus on prospective studies to determine optimal revascularization strategies for TAVR patients.
  • Functional assessment of coronary lesions, particularly using fractional flow reserve (FFR), should be considered, especially with TAVR expanding to younger, healthier populations.

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