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Coronary artery disease and its management in TAVI

Pedro Custódio1, Sérgio Madeira2, Rui Teles2

  • 1Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.

Hellenic Journal of Cardiology : HJC = Hellenike Kardiologike Epitheorese
|September 9, 2023
PubMed

Insights

The presence of obstructive coronary artery disease (CAD) and its treatment do not impact survival after transcatheter aortic valve intervention (TAVI). However, complex coronary lesions are associated with decreased survival post-TAVI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist.
  • Optimal preprocedural evaluation and revascularization strategies for CAD in transcatheter aortic valve intervention (TAVI) candidates remain debated.
  • Understanding the impact of CAD on TAVI outcomes is crucial for patient management.

Purpose of the Study:

  • To determine the prevalence and angiographic characteristics of CAD in TAVI candidates.
  • To assess revascularization patterns in this patient group.
  • To evaluate the impact of CAD presence, complexity, and percutaneous coronary intervention (PCI) on prognosis after TAVI.

Main Methods:

  • A single-center retrospective study analyzed data from a prospectively collected registry of TAVI patients (2009-2018).
  • Coronary angiography (CA) data was collected pre-TAVI.
  • Multivariate analysis assessed the effect of CAD and PCI on 2-year mortality.

Main Results:

  • Out of 379 patients, 14.5% had normal coronary arteries, 31.6% had non-obstructive CAD, and 53.8% had obstructive CAD.
  • Percutaneous coronary intervention (PCI) was performed in 29% of patients.
  • Two-year survival was reduced in patients with complex coronary lesions (Syntax Score > 22), but not by the presence of non-obstructive or obstructive CAD, residual disease, or pre-TAVI PCI.

Conclusions:

  • The overall presence and management of obstructive CAD did not significantly affect 2-year mortality after TAVI.
  • Survival was notably decreased in patients presenting with complex coronary anatomies.
  • These findings suggest that focusing on complex coronary lesions may be more critical than routine revascularization for all CAD in TAVI candidates.
Abstract

Keywords:
AorticCoronaryInterventionStableValve

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