Impact of coronary artery disease and percutaneous coronary intervention in women undergoing transcatheter aortic valve replacement: From the WIN‐TAVI registry

Abstract

Objectives: To evaluate the impact of coronary artery disease (CAD) with or without recent (≤ 30 days) percutaneous coronary intervention (PCI) in women undergoing transcatheter aortic valve replacement (TAVR).Background: Although women display a specific risk-profile for both PCI and TAVR, the impact of CAD and PCI in the setting of TAVR in women is unclear. Methods:The multinational Women's International Transcatheter Aortic Valve implantation registry enrolled consecutive female patients undergoing contemporary TAVR in 19 centers between 2013 and 2015. Patients with available coronary angiography or CT scan in the pre-operative assessment of TAVR were categorized as without CAD, with CAD but no recent PCI and CAD and recent PCI (≤30 days). All events were adjudicated according to the VARC-2 criteria.Results: A total of 787 patients were included in this analysis, among whom 459 (58.3%) had no CAD, 247 (31.4%) had CAD without recent PCI and 81 (10.3%) underwent recent PCI (≤ 30 days before TAVR). After multivariable adjustment, both groups of CAD patients, without and with recent PCI, presented with higher risk of death, myocardial infarction or stroke, compared with patients without CAD ( adj HR 1.56, 95%CI 1.03-2.39, P = 0.038 and adj HR 1.96, 95% CI 1.1-3.5, P = .021, respectively). Patients with recent PCI had increased risk of all-cause death ( adj HR 1.89, 95% CI 1.0-3.5, P = 0.04) and stroke ( adj HR 3.7, 95% CI 1.0-13.5, P = 0.046) compared with patients without CAD. Conclusion:The presence of CAD in women undergoing TAVR, with or without recent PCI, was associated with long-term poorer outcomes. K E Y W O R D Saortic stenosis, gender issue, transcatheter aortic valve replacement

Sex and Transcatheter Aortic Valve Implantation: Impact of Female Sex on Clinical Outcomes

“…For example, a positive history of coronary artery disease at baseline, with or without recent coronary intervention, is associated with adverse 1-year outcomes. [16] Similarly, baseline AF is a predictor of increased all-cause and cardiovascular mortality at 12 months (adjusted HR 1.67 and 1.85, respectively) in multivariate analysis. [17]…”

Incidence, predictors and clinical impact of permanent pacemaker insertion in women following transcatheter aortic valve implantation: Insights from a prospective multinational registry

“…The WIN-TAVI registry has been previously described. [13][14][15][16] Briefly, this prospective registry included women undergoing TAVR with a commercially available device for symptomatic aortic stenosis in 19 high-volume centers in Europe and the United States between January 2013 and December 2015. All patients were deemed suitable for TAVR by the local heart team and provided informed consent to their data's anonymous processing.…”

“…The WIN‐TAVI registry has been previously described 13–16 . Briefly, this prospective registry included women undergoing TAVR with a commercially available device for symptomatic aortic stenosis in 19 high‐volume centers in Europe and the United States between January 2013 and December 2015.…”

“…Pre-existing right bundle branch block (RBBB) was associated with a high risk of post-TAVR PPI (OR 3.62, 95% CI 1.85-7.06, p < 0.001), while implantation of balloon-expandable prosthesis was associated with a lower risk (OR 0.47, 95% CI 0.30-0.74, p < 0.001). Post-TAVR PPI prolonged in-hospital stay by a median of 2 days (11 [9][10][11][12][13][14][15][16] days in PPI vs. 9 [7][8][9][10][11][12][13][14] days in no-PPI, p = 0.005), yet risks of VARC-2 efficacy and safety endpoints at 1 year were similar in both groups ( adj HR 0.95, 95% CI 0.60-1.52, p = 0.84 and adj HR 1.22, 95% CI 0.83-1.79, p = 0.31, respectively).…”

Coronary Artery Disease and Revascularization in Patients Undergoing Transcatheter Aortic Valve Replacement

“…There are several considerations regarding the safety and feasibility of each approach. Table 2 highlights several studies comparing outcomes of patients undergoing TAVR with concomitant PCI versus TAVR alone [47][48][49][50][51].…”