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Impact of untreated chronic obstructive coronary artery disease on outcomes after transcatheter aortic valve
Ian Persits1, Habib Layoun2, Nicholas P Kondoleon1
1Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
European Heart Journal
|January 25, 2024
Summary
Transcatheter aortic valve replacement (TAVR) is safe for patients with untreated obstructive coronary artery disease (CAD). Expectant management of CAD during TAVR shows low procedural risks and acceptable long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Optimal management of chronic obstructive coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) is not established.
- Current strategies include pre-TAVR percutaneous coronary intervention or expectant management.
Purpose of the Study:
- To evaluate the impact of untreated obstructive CAD severity on TAVR procedural outcomes and longer-term results.
- To compare outcomes between patients with non-obstructive CAD and varying degrees of obstructive CAD undergoing TAVR.
Main Methods:
- Retrospective cohort study of 1911 TAVR recipients from January 2015 to November 2021.
- Patients were categorized based on CAD severity: non-obstructive, intermediate-risk, high-risk, and extreme-risk obstructive CAD.
- Key outcomes included procedural mortality/complications, major adverse cardiovascular events, and post-TAVR unplanned coronary revascularization.
Main Results:
- Procedural complication rates were low and similar across all CAD severity groups.
- At 21-month follow-up, acute coronary syndrome and unplanned revascularization rates increased with CAD severity (P < .001).
- Multivariable analysis showed no significantly increased risk of mortality or major adverse cardiovascular events based on CAD severity.
Conclusions:
- TAVR can be safely performed in patients with untreated obstructive CAD.
- Expectant management of obstructive CAD during TAVR is associated with low procedural risks.
- Rates of unplanned revascularization and acute coronary syndrome at one year are relatively low, even with obstructive CAD.
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