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Updated: May 21, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
06:04

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Published on: August 8, 2025

Clinical Impact of Myocardium at Risk in Transcatheter Aortic Valve Implantation

Cristina Aurigemma1, Giuliano Costa2, Giulia Laterra3

  • 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy (C.A., M.L., F. Burzotta).

Circulation. Cardiovascular Interventions
|May 20, 2026
PubMed

Insights

In patients undergoing transcatheter aortic valve implantation (TAVI) with coronary artery disease, residual myocardial risk significantly impacts outcomes. A higher residual British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS) after revascularization is linked to increased major adverse events.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Management of coronary artery disease (CAD) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) remains a clinical challenge.
  • The impact of residual myocardial risk after revascularization in this patient group requires further investigation.

Purpose of the Study:

  • To investigate the clinical impact of residual myocardial risk, assessed by the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS), on outcomes in patients undergoing TAVI.

Main Methods:

  • The REVASC-TAVI registry included patients with CAD undergoing TAVI and planned coronary revascularization.
  • Patients were stratified by residual BCIS-JS (rBCIS-JS) into extensive (>4) and non-extensive (≤4) residual myocardial risk groups.
  • The primary endpoint was a composite of all-cause death, myocardial infarction, stroke, and heart failure rehospitalization at 2 years.

Main Results:

  • Among 294 propensity-matched pairs, patients with rBCIS-JS >4 had a higher incidence of the primary endpoint (37.5% vs. 23.0%, P=0.004) at 2 years.
  • Myocardial infarction rates were significantly lower in the rBCIS-JS ≤4 group (2.6% vs. 8.2%, P=0.011).
  • rBCIS-JS >4 independently predicted 2-year major adverse cardiac and cerebrovascular events (HR, 1.43; P=0.005).

Conclusions:

  • Residual myocardial risk significantly influences TAVI outcomes in patients with concomitant CAD and severe aortic stenosis.
  • An rBCIS-JS >4 is associated with increased rates of major adverse cardiac and cerebrovascular events within 2 years post-TAVI.
Abstract

Keywords:
aortic valve stenosisheart failurehumansincidencestroke

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