Impact of Coronary Artery Revascularization Completeness on Outcomes of Patients With Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement
Key result
Incomplete revascularization in patients undergoing TAVR was associated with increased mortality compared to reasonable incomplete revascularization (OR 1.69; 95% CI 1.26–2.28; P<0.001).
Why the study?
Does incomplete revascularization increase mortality compared to reasonable incomplete revascularization or no CAD in patients undergoing transcatheter aortic valve replacement?
Population
3,107 patients from 6 studies undergoing transcatheter aortic valve replacement with coronary artery disease
Comparison
Incomplete revascularization defined by residual… vs Reasonable incomplete revascularization or no CAD
Design
Meta-analysis
Follow-up
0.7 to 3 years
Authors
Discussion
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Implication
Incomplete revascularization may signal higher TAVR mortality risk; extends observational data but leaves causality and practice change open.
Key Points
- To determine the prognostic impact of coronary artery revascularization completeness, assessed using the residual SYNTAX score, in patients with coronary artery disease undergoing transcatheter aortic valve replacement.
- Conducted a systematic review and meta-analysis of 6 studies comprising 3,107 patients undergoing transcatheter aortic valve replacement.
- Stratified revascularization status into reasonable incomplete revascularization (ICR) and ICR using study-specific residual SYNTAX score thresholds, across follow-up durations of 0.7 to 3 years.
- Incomplete revascularization significantly increased mortality risk compared with no CAD (OR 1.85, 95% CI 1.42–2.40, P < 0.01), reasonable ICR (OR 1.69, 95% CI 1.26–2.28, P < 0.001), and both groups combined (OR 1.71, 95% CI 1.36–2.16, P < 0.001).
- Reasonable incomplete revascularization did not significantly increase mortality risk compared with no CAD (OR 1.11, 95% CI 0.89–1.39, P = 0.33).
Study Design
Type
Meta-Analysis (n=3,107)
Structured PICO
Does incomplete revascularization increase mortality compared to reasonable incomplete revascularization or no CAD in patients undergoing transcatheter aortic valve replacement?
P
Population
3,107 patients from 6 studies undergoing transcatheter aortic valve replacement with coronary artery disease (CAD)
I
Intervention
Incomplete revascularization (ICR) defined by residual SYNTAX score
C
Comparator
Reasonable incomplete revascularization (ICR) or no CAD
O
Outcome
Mortalityhard clinical
Main Result
Effect estimate: OR 1.69 (95% CI 1.26-2.28)
p-value: p=<0.001
In patients undergoing transcatheter aortic valve replacement, incomplete coronary revascularization is associated with significantly higher mortality compared to reasonable incomplete revascularization or having no CAD.
Cite This Study
Witberg et al. (2018) conducted a meta-analysis in Coronary artery disease undergoing transcatheter aortic valve replacement (n=3,107). Incomplete revascularization (ICR) vs. Reasonable ICR or no CAD was evaluated on Mortality (OR 1.69, 95% CI 1.26-2.28, p=<0.001). Incomplete revascularization in patients undergoing TAVR was associated with increased mortality compared to reasonable incomplete revascularization (OR 1.69; 95% CI 1.26–2.28; P<0.001).