Impact of Coronary Artery Disease and Revascularization on Outcomes After Transcatheter Tricuspid Edge-to-Edge Repair

BACKGROUND: Coronary artery disease (CAD) is common in patients treated for structural heart disease, but its prevalence, prognostic impact, and optimal management in patients undergoing tricuspid transcatheter edge-to-edge repair (T-TEER) remain uncertain. OBJECTIVES: The aim of this study was to examine whether the presence of CAD, its anatomical complexity, and the extent of revascularization influence outcomes after T-TEER. METHODS: In this observational study, 361 consecutive T-TEER patients underwent preprocedural coronary angiography with SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scoring. CAD was defined as ≥70% stenosis (≥50% for the left main coronary artery). Residual SYNTAX score was calculated if revascularization was performed. The primary endpoint was 12-month all-cause mortality. RESULTS: Obstructive CAD was present in 124 patients (34.3%), with low lesion complexity (median SYNTAX score 6; Q1-Q3: 3-9.75). Among CAD patients, 33.9% underwent revascularization, reducing the residual SYNTAX score to 4 (Q1-Q3: 2-7). During the 12-month follow-up period, 16.7% of patients died. Survival over the follow-up period did not differ significantly according to the presence of obstructive CAD, baseline SYNTAX score, or residual SYNTAX score (12-month mortality for CAD vs no CAD 17.5% vs 16.3%; log-rank P = 0.616). Interaction analysis revealed effect modification by procedural risk determined by TRI-SCORE: in patients at low and intermediate risk, elevated residual SYNTAX score was associated with lower survival over follow-up (12-month mortality 20.8% vs 6.4%; log-rank P = 0.016), whereas no association was observed in high-risk patients (27.6% vs 27.1%; log-rank P = 0.927). Adding residual SYNTAX to the TRI-SCORE improved risk stratification in low- and intermediate-risk CAD patients (ΔC = +0.099). CONCLUSIONS: Obstructive CAD is common but typically low in complexity among T-TEER candidates. In low- and intermediate-risk patients, a higher residual SYNTAX score is associated with reduced survival.