The Prognostic Effects of Coronary Disease Severity and Completeness of Revascularization on Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Only severe CAD was associated with increased mortality post-TAVR. More complete revascularization pre-TAVR may attenuate the association of severe CAD and mortality.

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

“…Having said that in 4/6 studies, 12,14,22,24 it was practically identical (8 or 9) and consistent with the accepted definition in the overall CAD population (eg, rSSs >8), 16 we conducted a subgroup analysis restricted to these trials, whose results were consistent with those of the overall results ( Figure II in the Data Supplement), which suggests that this definitions may be suitable to the TAVR population as well. As mentioned above, only 2 studies reported multivariate-adjusted HR for mortality, but they represented >60% of the sample size of this meta-analysis, and their results were again consistent with the results of the overall analysis (HR of 1.6 and 1.7, for the comparison of ICR versus no CAD/reasonable ICR [1.7 and 1.6]compared with an OR of 1.71 for the similar comparison in our meta-analysis).…”

“…Six studies (total of 3110 patients) were found to be eligible for inclusion after full text review. [12][13][14][22][23][24] All were observational studies, 2 multicenter and 4 single center studies. Follow-up period ranged from 0.7 to 3 years.…”

“…This is why, if we truly want to examine the prognostic effect of CAD in TAVR patients, it is imperative that we do so with stratification by disease severity. Focusing on patients in the most severe CAD stratum allows us to identify those who are expected to be at the most increased risk for CAD-related mortality and indeed most 13,14,22,23,26 though not all 12,27,28 studies that used the SYNTAX score showed a worse prognosis for the highest severity patients with CAD. From a clinical perspective, the most relevant question is not whether severe CAD is associated with increased mortality but rather whether appropriate and timely revascularization may mitigate this increased risk.…”

“…In both studies, 13 Because the rSS for the definition of ICR was not the same in all the studies, we conducted a subgroup analysis restricted to the 4 studies with a consistent definition of ICR (8 for three 12,14,24 and 9 for the fourth study 22 ) for our main comparison-overall mortality for patients with no CAD/reasonable ICR versus ICR: the results of the subgroup analysis were consistent with that of the main analysis (OR, 1.78; 95% CI, 1.23-2.56; P<0.001 for the subgroup of studies with consistent definition of ICR compared with OR, 1.71; 95% CI, …”

Coronary artery disease and myocardial revascularization in patients undergoing transcatheter aortic valve replacement

“…It is important to note that the results remain conflicting in view of other studies negating a prognostic role of obstructive CAD by applying similar definitions (4). However, data become more concordant in supporting a role of CAD particularly in the subset of patients with intermediate-to-high SYNTAX scores (4,5).…”