Related Experiment Video
Updated: May 28, 2026
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Impact of Coronary Artery Disease and Revascularization on Outcomes After Transcatheter Tricuspid Edge-to-Edge Repair
Muntadher Al Zaidi1, Elena Repges1, Atsushi Sugiura1
1Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
Insights
Coronary artery disease (CAD) is common in patients undergoing tricuspid transcatheter edge-to-edge repair (T-TEER). In lower-risk patients, a higher residual SYNTAX score after revascularization is linked to reduced survival.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) is prevalent in patients with structural heart disease.
- The impact of CAD on outcomes after tricuspid transcatheter edge-to-edge repair (T-TEER) is not well understood.
- Optimal management strategies for CAD in T-TEER candidates require further investigation.
Purpose of the Study:
- To assess the influence of CAD presence, complexity, and revascularization on T-TEER outcomes.
- To evaluate the prognostic significance of coronary anatomy and revascularization completeness.
- To determine if CAD impacts survival post-T-TEER.
Main Methods:
- Observational study of 361 T-TEER patients with preprocedural coronary angiography.
- Coronary artery disease (CAD) defined by ≥70% stenosis (≥50% for left main).
- SYNTAX score used for lesion complexity; residual SYNTAX score calculated post-revascularization.
Main Results:
- Obstructive CAD found in 34.3% of patients, typically low complexity (median SYNTAX score 6).
- Revascularization performed in 33.9% of CAD patients, reducing residual SYNTAX score to 4.
- No significant difference in 12-month mortality based on CAD presence or baseline SYNTAX score.
- In low- and intermediate-risk patients (TRI-SCORE), higher residual SYNTAX score correlated with lower survival (P=0.016).
- Residual SYNTAX score improved risk stratification in low- and intermediate-risk CAD patients when added to TRI-SCORE.
Conclusions:
- Obstructive CAD is frequent but generally low complexity in T-TEER candidates.
- Higher residual SYNTAX scores are associated with reduced survival in low- and intermediate-risk T-TEER patients.
- Risk stratification models can be enhanced by incorporating residual SYNTAX scores in specific patient groups.
Background:
Coronary artery disease (CAD) is common in patients treated for structural heart disease, but its prevalence, prognostic impact, and optimal management in patients undergoing tricuspid transcatheter edge-to-edge repair (T-TEER) remain uncertain.
Objectives:
The aim of this study was to examine whether the presence of CAD, its anatomical complexity, and the extent of revascularization influence outcomes after T-TEER.
Methods:
In this observational study, 361 consecutive T-TEER patients underwent preprocedural coronary angiography with SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scoring. CAD was defined as ≥70% stenosis (≥50% for the left main coronary artery). Residual SYNTAX score was calculated if revascularization was performed. The primary endpoint was 12-month all-cause mortality.
Results:
Obstructive CAD was present in 124 patients (34.3%), with low lesion complexity (median SYNTAX score 6; Q1-Q3: 3-9.75). Among CAD patients, 33.9% underwent revascularization, reducing the residual SYNTAX score to 4 (Q1-Q3: 2-7). During the 12-month follow-up period, 16.7% of patients died. Survival over the follow-up period did not differ significantly according to the presence of obstructive CAD, baseline SYNTAX score, or residual SYNTAX score (12-month mortality for CAD vs no CAD 17.5% vs 16.3%; log-rank P = 0.616). Interaction analysis revealed effect modification by procedural risk determined by TRI-SCORE: in patients at low and intermediate risk, elevated residual SYNTAX score was associated with lower survival over follow-up (12-month mortality 20.8% vs 6.4%; log-rank P = 0.016), whereas no association was observed in high-risk patients (27.6% vs 27.1%; log-rank P = 0.927). Adding residual SYNTAX to the TRI-SCORE improved risk stratification in low- and intermediate-risk CAD patients (ΔC = +0.099).
Conclusions:
Obstructive CAD is common but typically low in complexity among T-TEER candidates. In low- and intermediate-risk patients, a higher residual SYNTAX score is associated with reduced survival.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction