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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.
Summary
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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