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Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
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Angiographic Functional Scoring of Coronary Artery Disease Predicts Mortality in Patients With Severe Aortic Stenosis

Michael Michail1, Udit Thakur2, Andrea Comella2

  • 1Monash Cardiovascular Research Centre, Monash University, MonashHeart, Monash Health, Melbourne, Australia; Institute of Cardiovascular Science, University College London, London, United Kingdom.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|May 4, 2020
PubMed

Insights

Functional scoring of coronary artery disease (CAD) using the DILEMMA score (DS) predicts mortality after transcatheter aortic valve replacement (TAVR). This functional assessment is crucial for understanding CAD

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) is prevalent in patients undergoing transcatheter aortic valve replacement (TAVR).
  • The prognostic significance of CAD, particularly its functional impact, in TAVR patients remains uncertain.
  • The DILEMMA score (DS) is a validated tool for assessing the functional significance of CAD.

Purpose of the Study:

  • To evaluate the impact of functionally significant CAD on clinical outcomes in patients undergoing TAVR for severe aortic stenosis (AS).
  • To compare the prognostic value of angiographic scoring systems (SYNTAX score and DILEMMA score) in this patient cohort.

Main Methods:

  • A total of 229 patients undergoing TAVR were analyzed.
  • Patients underwent angiographic assessment using both the SYNTAX score (SS) and the DILEMMA score (DS).
  • Primary endpoint was one-year all-cause mortality; secondary endpoint was 30-day major adverse cardiac and cerebrovascular events (MACCE).

Main Results:

  • While anatomical CAD (≥30% stenosis) was not associated with adverse outcomes, high SS (>9) or high DS (>2) predicted increased one-year mortality.
  • Both SS and DS were associated with 30-day MACCE.
  • Multivariate analysis identified DS > 2, reduced left ventricular ejection fraction (<50%), and COPD as independent predictors of one-year mortality.

Conclusions:

  • Angiographic functional scoring, specifically the DILEMMA score, is an independent predictor of mortality and MACCE in TAVR patients.
  • Functional assessment of CAD provides prognostic information beyond anatomical severity in patients undergoing TAVR.
Abstract

Keywords:
Aortic stenosis, coronary artery diseaseCoronary physiologyTranscatheter aortic valve replacement

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