Influence of coronary artery disease and percutaneous coronary intervention on mid‐term outcomes in patients with aortic valve stenosis treated with transcatheter aortic valve implantation

Abstract

Background A high frequency of coronary artery disease (CAD) is reported in patients with severe aortic valve stenosis (AS) who undergo transcatheter aortic valve implantation (TAVI). However, the optimal management of CAD in these patients remains unknown. Hypothesis We hypothesis that AS patients with TAVI complicated by CAD have poor prognosis. His study evaluates the prognoses of patients with CAD and severe AS after TAVI. Methods We divided 186 patients with severe AS undergoing TAVI into three groups: those with CAD involving the left main coronary (LM) or proximal left anterior descending artery (LAD) lesion (the CAD[LADp] group), those with CAD not involving the LM or a LAD proximal lesion (the CAD[non‐LADp] group), and those without CAD (Non‐CAD group). Clinical outcomes were compared among the three groups. Results The CAD[LADp] group showed a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) and all‐cause mortality than the other two groups (log‐rank p = .001 and p = .008, respectively). Even after adjustment for STS score and percutaneous coronary intervention (PCI) before TAVI, CAD[LADp] remained associated with MACCE and all‐cause mortality. However, PCI for an LM or LAD proximal lesion pre‐TAVI did not reduce the risk of these outcomes. Conclusions CAD with an LM or LAD proximal lesion is a strong independent predictor of mid‐term MACCEs and all‐cause mortality in patients with severe AS treated with TAVI. PCI before TAVI did not influence the outcomes.

Updates on the Role of Interventional Radiology in Ischemic Patients Undergoing Aortic Valve Replacement: Systematic Review

“…Only three studies reported a clear percentage of the success rate, which ranged from 92.3% (Ferreira-Neto et al, 2019) to 100% (Perrin et al, 2022). One study reported that 15.6% of cases demonstrated a success rate without any complications (Kaihara et al, 2021). The majority of the included studies reported that TAVI/ TAVR combined with the PCI technique is a safe and efficacious procedure for managing patients with AS.…”

“…Table 1 includes the sociodemographic characteristics. All of the included studies comprised patients with underlying CAD except four studies (Denimal et al, 2021;Kaihara et al, 2021;Matta et al, 2021;Tran et al, 2022). A total of 6252 patients were included.…”

“…A total of 6252 patients were included. Five studies were conducted in the USA (Jeroudi et al, 2018;Guedeney et al, 2019;Abugroun et al, 2020;Ghrair et al, 2020;Tran et al, 2022), two in Switzerland (Winter et al, 2021;Perrin et al, 2022), two in France (Denimal et al, 2021;Matta et al, 2021), one in Japan (Kaihara et al, 2021), and one in Canada (Ferreira-Neto et al, 2019). Table 2 presents the characteristics of the included studies.…”

“…Table 2 presents the characteristics of the included studies. Nine studies are retrospective in nature (Ferreira-Neto et al, 2017;Jeroudi et al, 2018;Ghrair et al, 2020;Denimal et al, 2021;Kaihara et al, 2021;Matta et al, 2021;Perrin et al, 2022), and two are prospective studies (Guedeney et al, 2019;Winter et al, 2021). The SE, balloon-expandable, ES, and CoreValve are the most common valve types used in TAVI or TAVR.…”

Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation

“…3,4 Nevertheless, indication for treatment of significant CAD in TAVI setting still remains a matter of debate, due to the marked inconsistency of the available evidence, which are mainly based on nonrandomized data. 2,[5][6][7][8][9][10][11][12] In fact, whether performing PCI and achieving complete revascularization in patients undergoing TAVI would offer a clinical benefit in patients with significant CAD remains unclear. 13 The randomized, noninferiority ACTIVATION trial (Percutaneous Coronary Intervention Prior to Transcatheter Aortic Valve Implantation) showed that rates of death and rehospitalization at 1 year were similar between PCI and no PCI prior to TAVI.…”