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Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement

Milorad Zivkovic1, Sara Tomovic2, Ivan Busic2

  • 1Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia.

Current Problems in Cardiology
|August 6, 2023
PubMed

Insights

Acute coronary syndromes (ACS) after transcatheter aortic valve replacement (TAVR) have unique causes and poorer outcomes. This review examines ACS incidence, mechanisms, and treatment in TAVR patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • Transcatheter aortic valve replacement (TAVR) is increasingly used in younger, lower-risk patients, leading to longer survival.
  • Longer life expectancy post-TAVR increases the risk of future acute coronary events (ACS).
  • ACS in TAVR patients differs clinically from non-TAVR populations, with unique underlying mechanisms.

Purpose of the Study:

  • To review current data on ACS incidence, timing, and mechanisms following TAVR.
  • To analyze the causes of ACS in patients with prior TAVR procedures.
  • To examine optimal invasive treatment strategies and clinical outcomes for ACS in TAVR patients.

Main Methods:

  • Comprehensive literature review of studies investigating ACS after TAVR.
  • Analysis of reported incidence, timing, and etiological factors of ACS in TAVR recipients.
  • Evaluation of treatment approaches and short- and long-term outcomes.

Main Results:

  • Plaque rupture is a primary ACS cause, but nonatherothrombotic mechanisms (emboli, valve obstruction) are more frequent in TAVR patients.
  • TAVR patients with ACS undergo invasive management less frequently.
  • ACS in TAVR patients is linked to worse prognosis, higher mortality, and increased major adverse cardiovascular events (MACE).

Conclusions:

  • ACS following TAVR is an understudied but significant clinical issue with distinct characteristics and poor outcomes.
  • Understanding the unique mechanisms of ACS post-TAVR is crucial for developing effective management strategies.
  • Further research is needed to optimize treatment and improve prognosis for TAVR patients experiencing ACS.

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