Does the presence of coronary artery disease impact survival and functional outcomes in high-risk patients with aortic stenosis undergoing TAVI?
In high-risk patients referred for TAVI, the presence of CAD is frequent but does not preclude satisfactory outcomes or significantly impact survival at 1 year.
AIMS: To describe the characteristics of coronary artery disease (CAD) in high-risk patients with aortic stenosis (AS), and its impact on indications for transcatheter aortic valve implantation (TAVI), and on outcomes. METHODS AND RESULTS: Of 240 patients referred for TAVI, 230 had documented CAD status. Mean age was 81.5±8 years. Hundred and forty-four (63%) had CAD. Compared to patients with no CAD, those with CAD had a higher risk of mortality (EuroSCORE: 31±18%, vs. 23±11%, p=0.004). Overall, 145 patients (63%) underwent TAVI, 31 (13%) surgery, and 54 (24%) medical treatment. No patient was denied intervention because of the CAD. CAD led to re-orientate one patient (0.4%) towards surgery. PCI was performed before TAVI in 11 (7%). Survival rates were respectively 90% and 85% in the CAD and non-CAD groups (p=0.37) at 30 days, and 76.4±5.4% and 70.6±6.8% (p=0.28) at 1-year. At follow-up, functional status was similar in both groups and no further revascularisation was needed. CONCLUSIONS: In high-risk patients referred for TAVI, CAD is frequent and associated with worse baseline characteristics. It has a limited impact on indications for TAVI. It seldom requires revascularisation and does not preclude satisfactory outcomes after TAVI.
Gautier et al. (Thu,) studied this question.