Key result
Extensive residual myocardium at risk after PCI linked to ~43% higher 2-year MACCE risk.
Why the study?
The optimal management of coronary artery disease in patients with severe aortic stenosis undergoing TAVI remains debated.
Does achieving a residual myocardium at risk score (rBCIS-JS) ≤4 improve the composite of death, MI, stroke, or heart failure rehospitalization in patients with severe aortic stenosis and concomitant coronary artery disease undergoing TAVI?
Cohort (n=2,407)
Yes
Does achieving a residual myocardium at risk score (rBCIS-JS) ≤4 improve the composite of death, MI, stroke, or heart failure rehospitalization in patients with severe aortic stenosis and concomitant coronary artery disease undergoing TAVI?
Hazard Ratio: 1.43 (95% CI 1.11–1.84)
Absolute Event Rate: 37.5% vs 23%
p-value: p=0.005
In patients undergoing TAVI with concomitant coronary artery disease, leaving an extensive residual amount of jeopardized myocardium (rBCIS-JS >4) after planned PCI is independently associated with worse 2-year clinical outcomes.
Extensive residual myocardium at risk was associated with higher 2-year MACCE after TAVI; hypothesis-generating for complete revascularization trials.
BACKGROUND: The best management of coronary artery disease in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) is debated. We investigated the clinical impact of the residual extent of myocardium at risk in patients undergoing TAVI. METHODS: Patients enrolled in the REVASC-TAVI (Management of Myocardial Revascularization in Patients Undergoing TAVI With Coronary Artery Disease) international multicenter registry were stratified according to the myocardium jeopardized by coronary artery disease using the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS) after a planned coronary revascularization. A planned revascularization included percutaneous coronary interventions performed before TAVI, during TAVI, or within 1 month after TAVI. The study population was divided according to the residual BCIS-JS (rBCIS-JS): patients with extensive residual myocardial at risk (rBCIS-JS >4 group) and patients without extensive residual myocardial at risk (rBCIS-JS ≤4 group). The primary study end point was the composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and rehospitalization for heart failure at 2 years. RESULTS: Among the 2407 patients enrolled, 294 pairs of patients were selected by propensity matching and compared. At 2-year follow-up, the incidence of the primary end point was higher in patients with rBCIS-JS >4 compared with patients with rBCIS-JS ≤4 (37.5% versus 23.0%, P =0.004). A significantly lower rate of myocardial infarction was reported in patients with BCIS-JS ≤4 (8.2% versus 2.6%, P =0.011). At multivariate analysis, rBCIS-JS >4 (hazard ratio, 1.43 [95% CI, 1.11–1.84]; P =0.005) independently predicted 2-year major adverse cardiac and cerebrovascular events. CONCLUSIONS: In patients with concomitant coronary artery disease and severe aortic stenosis, the residual myocardial risk significantly affects TAVI outcomes. In particular, a rBCIS-JS >4 is associated with higher rates of major adverse cardiac and cerebrovascular events at 2 years.
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Aurigemma et al. (2026) conducted a cohort in Severe aortic stenosis with concomitant coronary artery disease (n=2,407). Extensive residual myocardium at risk (rBCIS-JS >4) vs. Without extensive residual myocardium at risk (rBCIS-JS ≤4) was evaluated on Composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and rehospitalization for heart failure at 2 years (HR 1.43, 95% CI 1.11-1.84, p=0.005). Extensive residual myocardium at risk (rBCIS-JS >4) after planned coronary revascularization independently increased the 2-year risk of major adverse cardiac and cerebrovascular events by 43% (HR 1.43).
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