Impact of residual coronary artery disease on patients undergoing TAVI: A meta-analysis of adjusted observational studies

Taha, Salma; Moretti, Claudio; D’Ascenzo, Fabrizio; Mieghem, Nicolás M. Van; Omedè, Pierluigi; Montefusco, Antonio; Ghany, Mohamed Abdel; Fouaad, Doaa; Demitry, Salwa R.; Biondi‐Zoccai, Giuseppe; Gaïta, Fiorenzo

doi:10.1016/j.ijcard.2014.11.150

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…Studies on TAVI Outcomes According to CAD Severity and Revascularisation Extent Coronary Revascularisation in TAVI p=0.006) 32. Consistently, a meta-analysis of 979 patients showed that a low extent of CAD, estimated as baseline or residual Syntax Score ≤10, did not negatively affect outcomes at 30 days and 1 year 33. Moreover, Van Mieghem and colleagues observed no impact on TAVI outcomes according to revascularisation status (complete or incomplete), nor by a residual Syntax score threshold of 8.…”

mentioning

confidence: 74%

Coronary Revascularisation in Transcatheter Aortic Valve Implantation Candidates: Why, Who, When?

Cao¹,

Chiarito²,

Pagnotta³

et al. 2018

Interventional Cardiology Review

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Coronary artery disease (CAD) and aortic stenosis (AS) frequently coexist. The presence of CAD has been consistently associated with an impaired prognosis in patients undergoing surgical aortic valve replacement during short- and long-term follow-up. Accordingly, current guidelines recommend coronary revascularisation of all significant stenoses in patients undergoing surgical aortic valve replacement. Conversely, the management of concomitant CAD in patients with severe AS undergoing transcatheter aortic valve implantation (TAVI) is still a matter of debate. The aim of this review article is to provide an overview on the role of coronary revascularisation in TAVI patients.

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confidence: 74%

Coronary Revascularisation in Transcatheter Aortic Valve Implantation Candidates: Why, Who, When?

Cao¹,

Chiarito²,

Pagnotta³

et al. 2018

Interventional Cardiology Review

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“…While both studies showed higher mortality at 1 year, only Khawaja et al demonstrated higher mortality at 30 days as well. These results were condensed into a meta‐analysis by Taha et al, which showed that a residual or baseline Syntax score ≤10 does not affect the clinical outcomes after TAVR. D'Ascenzo et al were the first to perform a pooled analysis on the prognostic role of CAD in TAVR outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The few published studies evaluating the impact of CAD on TAVR outcomes and long‐term survival show conflicting results . The 2 published meta‐analyses that have attempted to identify the role of CAD in patients undergoing TAVR showed that CAD did not significantly alter the outcomes of TAVR. However, those analyses were limited by small numbers of studies and patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of Coronary Artery Disease on 30‐Day and 1‐Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta‐Analysis

Sankaramangalam

Banerjee

Kandregula

et al. 2017

JAHA

102

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BackgroundThe impact of coronary artery disease (CAD) on outcomes after transcatheter aortic valve replacement (TAVR) is understudied. Literature on the prognostic role of CAD in the survival of patients undergoing TAVR shows conflicting results. This meta‐analysis aims to investigate how CAD impacts patient survival following TAVR.Methods and ResultsWe completed a comprehensive literature search of Embase, MEDLINE, and the Cochrane Library, and included studies reporting outcome of TAVR based on CAD status of patients for the analysis. From the initial 1631 citations, 15 studies reporting on 8013 patients were analyzed using a random‐effects model. Of the 8013 patients undergoing TAVR, with a median age of 81.3 years (79–85.1 years), 46.6% (40–55.7) were men and 3899 (48.7%) had CAD (ranging from 30.8% to 78.2% in various studies). Overall, 3121 SAPIEN/SAPIEN XT/SAPIEN 3 (39.6%) and 4763 CoreValve (60.4%) prostheses were implanted, with transfemoral access being the most frequently used approach for the implantation (76.1%). Our analysis showed no significant difference between patients with and without CAD for all‐cause mortality at 30 days post TAVR, with a cumulative odds ratio of 1.07 (95% confidence interval, 0.82–1.40; P=0.62). However, there was a significant increase in all‐cause mortality at 1 year in the CAD group compared with patients without CAD, with a cumulative odds ratio of 1.21 (95% confidence interval, 1.07–1.36; P=0.002).ConclusionsEven though coexisting CAD does not impact 30‐day mortality, it does have an impact on 1‐year mortality in patients undergoing TAVR. Our results highlight a need to revisit the revascularization strategies for concomitant CAD in patients with TAVR.

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“…To answer this question, stratifying patients with CAD using the SYNTAX score is inadequate because it does not take into account the possibility of pre-TAVR revascularization, and hence the most appropriate measure is the rSS, which reflects the completeness of revascularization pre-TAVR. There is one previous meta-analysis that examined the prognostic effect of the rSS in TAVR patients, 15 and it included only 2 single center studies 23,24 and did not find an rSS <10 to be associated with improved outcomes at 30-day followup compared with higher rSS. The authors acknowledged the limitation of their small sample size and the need for more data on this issue.…”

Section: Discussionmentioning

confidence: 99%

“…A small meta-analysis on this issue (2 trials, 899 patients overall) did not find more complete revascularization to be associated with improved 30-day outcomes post-TAVR. 15 Our objective was to conduct an updated systematic review and meta-analysis on the impact of revascularization completeness (as expressed by the rSS) and on overall survival in patients with both CAD and aortic stenosis undergoing TAVR.…”

mentioning

confidence: 99%

Impact of Coronary Artery Revascularization Completeness on Outcomes of Patients With Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement

Witberg

Zusman

Codner

et al. 2018

Circ: Cardiovascular Interventions

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Background-Coronary artery disease (CAD) is highly prevalent in patients undergoing transcatheter aortic valve replacement.In the overall CAD population, complete revascularization or reasonable incomplete revascularization (ICR) is associated with improved outcomes; whether the same applies for the transcatheter aortic valve replacement population is still a matter of debate. Methods and Results-We conducted a systematic review and meta-analysis of studies that examined the prognostic effect of revascularization completeness in patients undergoing transcatheter aortic valve replacement using the residual SYNTAX score (Synergy Between PCI With Taxus and Cardiac Surgery) to separate between reasonable ICR and ICR (using the individual threshold used by each study). Six studies with a total of 3107 patients were included. The duration of follow-up ranged from 0.7 to 3 years. Overall, ICR was associated with an increased risk for mortality. This was true when comparing ICR patients to those with no CAD (odds ratio,

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Impact of residual coronary artery disease on patients undergoing TAVI: A meta-analysis of adjusted observational studies

Cited by 7 publications

References 5 publications

Coronary Revascularisation in Transcatheter Aortic Valve Implantation Candidates: Why, Who, When?

Coronary Revascularisation in Transcatheter Aortic Valve Implantation Candidates: Why, Who, When?

Impact of Coronary Artery Disease on 30‐Day and 1‐Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta‐Analysis

Impact of Coronary Artery Revascularization Completeness on Outcomes of Patients With Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement

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