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Published on: June 3, 2018
Characterization and Management of Stable Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve
Sofia Sammartino1, Giulia Laterra2, Thomas Pilgrim3
1Department of Cardiology, University of Catania, 95124 Catania, Italy.
Insights
Patients undergoing transcatheter aortic valve implantation (TAVI) with obstructive coronary artery disease (CAD) often have single-vessel disease and proximal involvement. Percutaneous coronary intervention (PCI) is common, showing similar outcomes to conservative management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Limited data exists on obstructive, stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI).
- Understanding the characteristics, management, and outcomes of this patient group is crucial for clinical practice.
Purpose of the Study:
- To analyze detailed characteristics, treatment strategies, and outcomes of patients with obstructive, stable CAD undergoing TAVI.
- To evaluate the real-world effectiveness of percutaneous coronary intervention (PCI) versus conservative management in this population.
Main Methods:
- The REVASC-TAVI registry collected data from 2025 patients across 30 centers with obstructive, stable CAD undergoing TAVI.
- Patient characteristics, treatment decisions (PCI vs. conservative), and 2-year outcomes were analyzed using Kaplan-Meier estimates.
Main Results:
- Most patients had single-vessel CAD (56.1%), with frequent proximal coronary tract involvement (62.5%), including left main disease (12.0%).
- Percutaneous coronary intervention (PCI) was the predominant treatment (79.9%), particularly for proximal CAD (90.4%).
- At 2 years, no significant differences in all-cause death or major adverse cardiovascular events were observed between PCI and conservative management groups.
Conclusions:
- Obstructive CAD in TAVI patients often involves single vessels and proximal coronary tracts.
- Percutaneous coronary intervention is frequently employed and demonstrates comparable 2-year outcomes to conservative approaches in this cohort.
Abstract:
Background/Objectives: To date, data regarding the characteristics and management of obstructive, stable coronary artery disease (CAD) encountered in patients undergoing transcatheter aortic valve implantation (TAVI) are sparse. The aim of the study was to analyze granular details, treatment, and outcomes of patients undergoing TAVI with obstructive, stable CAD from real-world practice. Methods: REVASC-TAVI (Management of myocardial REVASCularization in patients undergoing Transcatheter Aortic Valve Implantation with coronary artery disease) is an investigator-initiated, multicenter registry, which collected data from patients undergoing TAVI with obstructive stable CAD found during the pre-TAVI work-up. Results: A total of 2025 patients from 30 centers worldwide with complete follow-up were included in the registry. Most patients had single-vessel CAD (56.1%). An involvement of proximal coronary tracts was detected in 62.5% of cases, with 12.0% of patients having CAD in left main (LM). Most patients received percutaneous coronary intervention (PCI) (n = 1617, 79.9%), especially those with proximal CAD (90.4%). At 2 years, the rates of all-cause death [Kaplan-Meier (KM) estimates 20.1% vs. 18.8%, plog-rank = 0.86] and of the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure (KM estimates 29.7% vs. 27.5%, plog-rank = 0.82) did not differ between patients undergoing PCI and those who were not. Conclusions: Patients undergoing TAVI with obstructive CAD more commonly had a single-vessel disease and an involvement of proximal coronary tracts. They were commonly treated with PCI, with similar outcomes compared to those treated conservatively.
