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Published on: August 8, 2025
Obstructive Coronary Artery Disease and Health Status in Transcatheter Aortic Valve Replacement: A Post Hoc Analysis
Daijiro Tomii1, Jonas Lanz1, Holger Thiele2
1Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
Insights
Obstructive coronary artery disease (CAD) did not significantly impact outcomes for patients undergoing transcatheter aortic valve replacement (TAVR). Survival and health status remained similar between patients with and without obstructive CAD three years post-TAVR.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials
Background:
- Aortic stenosis (AS) and obstructive coronary artery disease (CAD) frequently coexist.
- The influence of obstructive CAD on outcomes after transcatheter aortic valve replacement (TAVR) is debated.
- Understanding this association is crucial for optimizing TAVR patient management.
Purpose of the Study:
- To assess the impact of obstructive CAD on clinical and patient-reported outcomes in severe AS patients undergoing TAVR.
- To compare survival, health status, and clinical efficacy between TAVR patients with and without obstructive CAD.
Main Methods:
- Post hoc analysis of the SCOPE I randomized clinical trial.
- Included 732 patients with symptomatic severe AS undergoing TAVR.
- Obstructive CAD defined as >50% stenosis in a major coronary vessel; outcomes assessed at 3-year follow-up using Valve Academic Research Consortium (VARC)-3 definitions and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores.
Main Results:
- 51.0% of patients had obstructive CAD; 38.6% underwent percutaneous coronary intervention (PCI) periprocedurally.
- No significant differences in 3-year mortality, cardiovascular death, or VARC-3 clinical efficacy between obstructive CAD and no-CAD groups.
- Patient-reported health status (KCCQ scores) also showed no significant differences at baseline or 3-year follow-up.
- Myocardial infarction risk was numerically higher but not statistically significant in the obstructive CAD group.
- Periprocedural PCI did not improve outcomes in patients with obstructive CAD.
Conclusions:
- Obstructive CAD did not significantly affect survival, patient-reported health status, or TAVR clinical efficacy at 3 years.
- These findings suggest that the presence of obstructive CAD may not alter the overall success of TAVR.
- A tailored treatment approach is recommended for TAVR candidates with severe AS and coexisting CAD.
Importance:
Aortic stenosis (AS) and obstructive coronary artery disease (CAD) often coexist, yet the impact of obstructive CAD on clinical and patient-reported outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) remains a subject of ongoing debate.
Objectives:
To investigate the association of obstructive CAD with clinical outcomes and health status among patients with symptomatic severe AS undergoing TAVR.
Design, Setting, And Participants:
This post hoc analysis of the investigator-initiated, multicenter SCOPE I (Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis for Transcatheter Aortic Valve Implantation by Transfemoral Approach) randomized clinical trial was conducted at 20 tertiary heart centers in Europe from February 8, 2017, to February 2, 2019, with follow-up through 3 years. Data were analyzed from February 17 through August 13, 2025.
Exposure:
Presence vs absence of obstructive CAD, defined as greater than 50% stenosis in at least 1 major epicardial coronary vessel.
Main Outcomes And Measures:
Parameters of interest included vital and patient-reported disease-specific health status (Kansas City Cardiomyopathy Questionnaire [KCCQ] scores, ranging from 0 to 100, with higher numbers indicating better health status), and clinical efficacy according to Valve Academic Research Consortium (VARC)-3 definitions. Analyses were conducted using the as treated population.
Results:
Of 732 patients with symptomatic severe AS undergoing TAVR (mean [SD] age, 82 [4] years; 416 [56.8%] female), obstructive CAD was identified in 373 (51.0%), 144 (38.6%) of whom underwent elective percutaneous coronary intervention (PCI) during the periprocedural period. At 3 years after TAVR, there were no statistically significant differences in patient-reported health status (eg, median [IQR] baseline overall KCCQ scores with CAD, 54.2 [40.3-69.8] vs without CAD, 55.2 [38.5-72.9] and at 3-year follow-up with CAD, 79.7 [64.4-90.6] vs without CAD, 82.3 [68.2-91.7]), mortality (all-cause death: 88 of 373 [24.7%] vs 76 of 359 [22.3%], adjusted hazard ratio, [HR], 0.97 [95% CI, 0.66-1.43]; cardiovascular death: 59 of 373 [17.6%] vs 51 of 359 [15.5%], adjusted HR, 0.87 [95% CI, 0.54-1.42]), and clinical efficacy of TAVR (163 of 313 [52.1%] vs 159 of 298 [53.4%]; adjusted risk ratio, 1.10 [95% CI, 0.92-1.32]) between patients with vs without obstructive CAD. Having (vs not having) obstructive CAD was associated with a numerically albeit not statistically significantly higher risk of myocardial infarction (18 of 372 [5.5%] vs 3 of 359 [1.1%]; adjusted HR, 3.83 [95% CI, 0.96-15.31]). Periprocedural PCI among patients with obstructive CAD did not improve clinical outcomes, patient-reported health status, nor the integrated end points of clinical outcomes and quality of life measures.
Conclusions And Relevance:
In this post hoc analysis of SCOPE I, patients with obstructive CAD who underwent TAVR had no statistically significant differences in survival, patient-reported health status, or VARC-3 clinical efficacy compared with patients without CAD through 3 years of follow-up. Findings suggest that a tailored approach may be essential in the treatment of TAVR candidates with severe AS and CAD.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03011346.
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