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Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement

Laurent Faroux1, Erika Munoz-Garcia2, Vicenç Serra3

  • 1Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.).

Circulation. Cardiovascular Interventions
|January 30, 2020
PubMed

Insights

Acute coronary syndrome after transcatheter aortic valve replacement (TAVR) is linked to poor outcomes. Revascularization improves survival, while STEMI increases mortality risk in TAVR patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • Limited data exists on coronary events post-transcatheter aortic valve replacement (TAVR).
  • No prior studies have identified factors associated with adverse outcomes following TAVR-related acute coronary syndrome (ACS).

Purpose of the Study:

  • To investigate the clinical characteristics of ACS events in TAVR patients.
  • To determine the outcomes and prognostic factors associated with ACS following TAVR.

Main Methods:

  • A multicenter cohort study of 270 patients experiencing ACS post-TAVR.
  • Data collected included ACS presentation, procedural strategies, and clinical outcomes such as death, myocardial infarction, stroke, and major adverse cardiovascular or cerebrovascular events.

Main Results:

  • ACS presentations varied, with non-ST-segment-elevation myocardial infarction (STEMI) type 2 being most common (31.9%).
  • In-hospital mortality was 10.0%, and at median follow-up, overall mortality reached 43.0%.
  • Revascularization at ACS diagnosis reduced all-cause death risk (HR, 0.54), while STEMI increased mortality risk (HR, 2.06).

Conclusions:

  • ACS events in TAVR recipients have distinct characteristics and are associated with high mortality.
  • STEMI and lack of revascularization are significant risk factors for adverse outcomes.
  • Findings emphasize the need for improved prevention and management strategies for ACS post-TAVR.
Abstract

Keywords:
acute coronary syndromecoronary artery diseasemortalitypercutaneous coronary interventiontranscatheter aortic valve replacement

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