Key result
Extensive residual myocardium at risk after TAVI linked to ~43% higher risk of major events.
Why the study?
The best management of coronary artery disease in patients with severe aortic stenosis undergoing TAVI is debated.
Does extensive residual myocardium at risk (rBCIS-JS >4) increase the risk of adverse cardiovascular events in patients with severe aortic stenosis and coronary artery disease undergoing TAVI?
Observational (n=2,407)
Yes
Does extensive residual myocardium at risk (rBCIS-JS >4) increase the risk of adverse cardiovascular events in patients with severe aortic stenosis and coronary artery disease undergoing TAVI?
In patients undergoing TAVI with concomitant coronary artery disease, extensive residual myocardium at risk (rBCIS-JS >4) is associated with significantly higher rates of major adverse cardiac and cerebrovascular events at 2 years.
rBCIS-JS >4 after TAVI identifies higher MACCE risk; hypothesis-generating for revascularization trials, should not yet change practice.
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 an observational in Severe aortic stenosis and coronary artery disease (n=2,407). Extensive residual myocardium at risk (rBCIS-JS >4) vs. No 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=0.004). Extensive residual myocardium at risk (rBCIS-JS >4) after TAVI was associated with a higher 2-year rate of death, MI, stroke, or HF hospitalization than rBCIS-JS ≤4 (37.5% vs 23.0%, P=0.004).
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