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Impact of Incomplete Coronary Revascularization on Late Ischemic and Bleeding Events after Transcatheter Aortic Valve

Adrien Carmona1, Benjamin Marchandot1, François Severac2

  • 1Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67000 Strasbourg, France.

Journal of Clinical Medicine
|July 26, 2020
PubMed

Insights

Coronary artery disease burden and incomplete revascularization after PCI do not affect mortality in TAVR patients but increase bleeding risk. Elevated SYNTAX scores predict major bleeding complications post-TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • The prognostic impact of coronary artery disease (CAD) and percutaneous coronary intervention (PCI) in transcatheter aortic valve replacement (TAVR) patients is debated.
  • Elevated baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) are linked to poor outcomes in PCI patients.

Purpose of the Study:

  • To assess the influence of bSS and rSS on ischemic and bleeding events following TAVR.

Main Methods:

  • bSS and rSS were analyzed in 311 TAVR patients.
  • Primary outcome: Major Adverse Cardiac Events (MACE) - myocardial infarction, stroke, cardiovascular death, heart failure rehospitalization.
  • Secondary outcomes: Late Major/Life-Threatening Bleeding Complications (MLBCs) and individual MACE components.

Main Results:

  • bSS > 22 correlated with increased MACE (p=0.013).
  • Neither rSS > 8 nor bSS > 22 impacted overall cardiovascular mortality.
  • Both rSS > 8 and bSS > 22 were associated with higher rates of myocardial infarction and late MLBCs.
  • Multivariate analysis identified bSS > 22 (sHR 2.48) and rSS > 8 (sHR 2.35) as predictors of MLBCs, but not myocardial infarction.

Conclusions:

  • Incomplete revascularization and CAD burden do not influence overall or cardiac mortality in TAVR patients.
  • However, these factors predict late MLBCs in this patient cohort.
Abstract

Keywords:
baseline SYNTAX scorebleedingresidual SYNTAX scoretranscatheter aortic valve replacement

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