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Trends and Outcomes in Patients With Coronary Artery Disease Undergoing TAVR: Insights From VA CART

Khanjan B Shah1,2, Colin O'Donnell3, Dhruv Mahtta4

  • 1Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.

Journal of the Society for Cardiovascular Angiography & Interventions
|August 12, 2024
PubMed

Insights

Obstructive coronary artery disease (CAD) increases mortality after transcatheter aortic valve replacement (TAVR). However, pre-TAVR percutaneous coronary intervention (PCI) did not improve outcomes in this veteran population.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Services Research

Background:

  • Obstructive coronary artery disease (CAD) is prevalent in patients with severe symptomatic aortic stenosis.
  • The management and impact of CAD in patients undergoing transcatheter aortic valve replacement (TAVR) require further evaluation.

Purpose of the Study:

  • To determine patient characteristics and clinical outcomes of veterans undergoing TAVR with and without obstructive CAD.
  • To analyze temporal trends and the association of pre-TAVR percutaneous coronary intervention (PCI) with clinical outcomes.

Main Methods:

  • Retrospective analysis of TAVR patients within the VA Health Care System (2012-2021).
  • Stratification of patients based on obstructive CAD status and pre-TAVR PCI.
  • Primary outcome: 1-year all-cause mortality; Secondary outcome: major bleeding.

Main Results:

  • 37% of 759 TAVR patients had obstructive CAD, associated with higher 1-year mortality (15.6% vs 7.1%).
  • Pre-TAVR PCI rates varied over time, with 51% receiving it during the study period.
  • No significant difference in 1-year mortality or bleeding between patients with or without pre-TAVR PCI.

Conclusions:

  • Obstructive CAD is linked to increased mortality post-TAVR in veterans.
  • Pre-TAVR PCI did not demonstrate improved outcomes in this cohort.
  • Further research is needed to identify patients who may benefit from coronary revascularization before TAVR.
Abstract

Keywords:
Clinical Assessment, Reporting and Tracking ProgramVeterans Affairspercutaneous coronary interventiontranscathter aortic valve replacement

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