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Published on: June 3, 2018
Coronary Events After Transcatheter Aortic Valve Replacement: Insights From the France TAVI Registry
Sandra Zendjebil1, Mariama Akodad1, Bernard Iung2
1Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France.
Insights
Coronary events after transcatheter aortic valve replacement (TAVR) are infrequent but serious. Patients not receiving percutaneous coronary intervention (PCI) have worse outcomes, particularly those with self-expandable valves (SEV).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- High prevalence of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR).
- Treatment of coronary events (CE) post-TAVR presents significant technical challenges.
Purpose of the Study:
- To determine the incidence of coronary events (CE) following TAVR.
- To evaluate the prognostic impact of CE after TAVR.
Main Methods:
- Analysis of the France-TAVI registry including patients who received balloon-expandable valves (BEV) or self-expandable valves (SEV).
- Primary endpoint: first hospitalization for CE.
- Secondary endpoint: composite of all-cause mortality or heart failure hospitalization post-CE.
Main Results:
- CE occurred in 11.6% of 64,660 patients (1.5% per year); predictors included prior CAD and significant coronary stenosis pre-TAVR.
- Patients undergoing percutaneous coronary intervention (PCI) had better outcomes compared to those without PCI (79.6% vs. 85.2-86.5%).
- Self-expandable valve (SEV) patients experienced higher rates of unfavorable outcomes (85.8% vs. 83.8% for BEV) and lower PCI rates, especially at non-TAVR centers.
Conclusions:
- The annual incidence of coronary events post-TAVR is low.
- Patients experiencing CE without PCI have a poorer prognosis.
- SEV patients face higher risks of adverse outcomes and reduced likelihood of PCI, particularly when treated outside specialized TAVR centers.
Background:
The prevalence of coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is high. Treatment of a coronary events (CE) after TAVR can be technically challenging.
Objectives:
The authors sought to assess the incidence and prognostic impact of CE after TAVR.
Methods:
Patients undergoing TAVR for native aortic stenosis, with balloon-expandable valves (BEV) or self-expandable valves (SEV), included in the France-TAVI registry (Registry of Aortic Valve Bioprostheses Established by Catheter) were studied. The primary endpoint was the rate of first hospitalization for CE at maximal follow-up. The main secondary endpoint was the composite of all-cause mortality or hospitalization for heart failure following CE.
Results:
Between 2013 and 2021, 64,660 patients were included (BEV 63.8%, SEV 36.2%). CE occurred in 11.6% of cases (1.5%/y). Previous coronary artery disease and known coronary artery stenosis >50% before TAVR were the main predictors of CE. After CE, the composite endpoint was lower in patients who underwent percutaneous coronary intervention (PCI) compared with those who had only coronary angiography or no intervention (79.6%, 85.2%, and 86.5%, respectively; P = 0.002) and higher in SEV than in BEV patients (85.8% vs 83.8%; P = 0.01). Patients admitted to a TAVR center were more likely to have PCI (OR: 1.20 [95% CI: 1.01-1.42]; P = 0.04), even more so if they had a BEV (OR: 1.42 [95% CI: 1.18-1.71]; P = 0.002).
Conclusions:
The yearly incidence of CE after TAVR is low. In the event of CE, patients who have not undergone PCI have a worse outcome. SEV patients have a higher rate of unfavorable outcomes and are less likely to undergo PCI, especially when admitted to non-TAVR centers.
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