Response to Letter Regarding Article “Percutaneous Coronary Intervention in Patients With Severe Aortic Stenosis: Implications for Transcatheter Aortic Valve Replacement”

Goel, Sachin S.; Agarwal, Shikhar; Tuzcu, E. Murat; Ellis, Stephen G.; Zaman, Tarique; Patel, Neil; Aksoy, Olcay; Stewart, William J.; Griffin, Brian P.; Kapadia, Samir; Svensson, Lars G.; Bajaj, Navkaranbir S.; Joseph, Lee

doi:10.1161/circulationaha.112.121673

Cited by 27 publications

(40 citation statements)

References 1 publication

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“…Kleczynski et al showed that incomplete coronary revascularization may be an independent predictor of all‐cause mortality after TAVR; however, on the contrary, Van Meighem et al state that complete revascularization is not a prerequisite for success in current TAVR practice. Even though Goel et al showed that PCI can be performed in patients with severe symptomatic AS and CAD without an increased risk of short‐term mortality, considerable uncertainty persists regarding the timing of revascularization (concomitant versus staged). This meta‐analysis highlights the need for further randomized studies to find the optimal revascularization strategy for CAD in TAVR candidates and to ascertain the impact of nonrevascularized myocardium in TAVR outcomes.…”

Section: Discussionmentioning

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

Self Cite

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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Section: Discussionmentioning

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

Self Cite

102

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“…However, percutaneous coronary intervention (PCI) in the presence of severe aortic stenosis (AS) is associated with an increased risk of major adverse cardiac and cerebrovascular events (MACCE) in part due to an inability of the pressure overloaded left ventricle (LV) to tolerate peri‐procedural ischemia. Additionally, the presence of impaired LV systolic function may increase the hazard further .…”

Section: Introductionmentioning

confidence: 99%

Feasibility and efficacy of the 2.5 L and 3.8 L impella percutaneous left ventricular support device during high‐risk, percutaneous coronary intervention in patients with severe aortic stenosis

Spiro

Venugopal

Raja

et al. 2014

Cathet Cardio Intervent

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“…A recent observational study led by Goel et al [24] compared PCI outcomes of over 250 patients with severe AS. These patients were propensity matched to a cohort of individuals without AS who had PCI under comparable clinical conditions.…”

Section: Outcomes Of Surgical Aortic Valve Replacement In Patients Wimentioning

confidence: 99%

Coronary artery disease and transcatheter aortic valve replacement

Paradis

Labbé

Rodés‐Cabau

2015

Coronary Artery Disease

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Aortic stenosis is the most common form of valvular heart disease in the elderly population and is often diagnosed in individuals who also have coronary artery disease. Surgical aortic valve replacement has been the standard of care for the treatment of aortic stenosis during the past decades, but the availability of transcatheter aortic valve replacement has now allowed different options for high or extreme surgical risk patients. The management of coronary artery disease in patients undergoing transcatheter aortic valve replacement remains a controversial issue, as available studies in the literature have generated conflicting results. This review offers a comprehensive portrait of coronary artery disease management in the presence of concomitant aortic stenosis and proposes treatment approaches for patients presenting both diseases.

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Response to Letter Regarding Article “Percutaneous Coronary Intervention in Patients With Severe Aortic Stenosis: Implications for Transcatheter Aortic Valve Replacement”

Cited by 27 publications

References 1 publication

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

Feasibility and efficacy of the 2.5 L and 3.8 L impella percutaneous left ventricular support device during high‐risk, percutaneous coronary intervention in patients with severe aortic stenosis

Coronary artery disease and transcatheter aortic valve replacement

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