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Published on: June 3, 2018
Coronary CT angiography instead of invasive angiography before TAVI: Feasibility and outcomes
Rebekka Vibjerg Jensen1, Jesper Møller Jensen1, Nadia Iraqi1
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Coronary CT angiography (cCTA) is a safe and feasible alternative to invasive coronary angiography (ICA) for assessing coronary artery disease (CAD) in transcatheter aortic valve implantation (TAVI) candidates, showing similar outcomes.
Area of Science:
- Cardiology
- Radiology
- Interventional Cardiology
Background:
- Concomitant coronary artery disease (CAD) is common in patients undergoing transcatheter aortic valve implantation (TAVI).
- Current guidelines recommend invasive coronary angiography (ICA) for CAD assessment before TAVI, but its prognostic value and the benefits of revascularization remain uncertain.
- The optimal diagnostic strategy for coronary assessment in TAVI candidates requires further investigation.
Purpose of the Study:
- To evaluate the feasibility, safety, and clinical outcomes of using cardiac CT angiography (cCTA) as the primary imaging modality for coronary assessment in TAVI candidates.
- To compare outcomes between patients assessed with cCTA alone versus those who underwent subsequent ICA.
Main Methods:
- A single-center observational cohort study included 240 TAVI candidates between April 2020 and November 2021.
- Coronary artery disease was initially assessed by cCTA. Patients with significant proximal or left main stenosis, or non-evaluable cCTA, proceeded to ICA.
- Outcomes including procedural complications and mortality were compared between groups.
Main Results:
- 92% of patients demonstrated atherosclerosis on cCTA.
- 80% of patients (n=191) were assessed by cCTA only, while 20% (n=49) underwent subsequent ICA.
- Median follow-up was 15 months, with no significant differences in procedural complications, mortality, or unplanned ICAs between the cCTA-only and cCTA+ICA groups.
Conclusions:
- Upfront cCTA is a feasible and safe strategy for evaluating obstructive CAD in severe aortic stenosis patients referred for TAVI.
- This approach yields similar procedural and clinical outcomes compared to strategies involving upfront ICA.
- Further randomized trials are needed to confirm the safety and efficacy of cCTA over ICA for coronary assessment in TAVI candidates.
Aims:
Concomitant coronary artery disease (CAD) is frequent in transcatheter aortic valve implantation (TAVI) candidates. Despite societal recommendations of performing invasive coronary angiography (ICA) for coronary assessment in the pre-TAVI diagnostic workup, the prognostic value of ICA and beneficial effect of revascularization in these patients remains unclear. We aimed to determine feasibility and outcomes following a strategy of cardiac CT + coronary CT angiography (cCTA) rather than cardiac CT + ICA before TAVI.
Methods And Results:
We performed a single-center, observational cohort study including all patients, without previous coronary intervention, referred to TAVI between April 2020 and November 2021. CAD was assessed by cCTA, and only patients with proximal stenosis >70 %, or left main stenosis >50 %, or cCTA was non-evaluable regarding proximal segments were subsequently referred to ICA. 240 patients were included in the study. No adverse effects to pre-cCTA-scan nitroglycerin administration were observed. On cCTA, 92 % of the patients had atheroscerosis. 191 (80 %) patients had cCTA only performed, while 49 (20 %) patients underwent subsequent ICA. During a median (range) follow-up of 15 (6-25) months, no difference in procedural complication rates, mortality rates, or number of unplanned ICA was observed between patients evaluated with only cCTA vs cCTA+ICA.
Conclusions:
Upfront cCTA instead of ICA for assessment of obstructive CAD in the diagnostic workup of patients with severe aortic stenosis referred to TAVI is feasible, safe, and with similar procedural and clinical outcomes. Randomized studies are warranted to further validate the safety of using CTA rather than ICA for coronary assessment in TAVI candidates.
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