Key result
In patients with coronary artery disease undergoing transcatheter aortic valve replacement, revascularization prior to TAVR is recommended for high SYNTAX scores (>22), while decisions for intermediate scores should be individualized.
Why the study?
The optimal method of CAD revascularisation in patients undergoing TAVR remains unknown due to a lack of RCTs and the exclusion of significant CAD in TAVR trials.
Does revascularization of coronary artery disease improve post-TAVR outcomes in patients undergoing TAVR?
Does revascularization of coronary artery disease improve post-TAVR outcomes in patients undergoing TAVR?
The optimal management of CAD in patients undergoing TAVR remains unclear due to a lack of RCTs, necessitating individualized heart team discussions.
Supports pre-TAVR revascularization for high SYNTAX scores; leaves open optimal management of intermediate scores absent RCTs.
Aortic stenosis and coronary artery disease (CAD) frequently co-exist, as they share a common pathophysiology and risk factors. Due to lack of randomised controlled trials (RCTs) and exclusion of significant CAD in transcatheter aortic valve replacement (TAVR) trials, the optimal method of revascularisation of CAD in patients undergoing TAVR remains unknown. Observational studies and meta-analyses have shown varied results in outcomes for patients with CAD undergoing TAVR, and no significant difference in post-TAVR outcomes in patients who underwent revascularisation either prior to or during TAVR versus those who did not. However, some observational studies have shown that patients with lower residual SYNTAX score (rSS) post-revascularisation have better outcomes post-TAVR compared to those with higher rSS. RCTs are needed to clearly understand whether revascularisation is beneficial in these patients. Until then, management of CAD in patients undergoing TAVR must be individualised based on discussion with the heart team.
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Katta et al. (2020) conducted a review in Aortic stenosis and concomitant coronary artery disease. Percutaneous coronary intervention (PCI) vs. Isolated TAVR was evaluated. In patients with coronary artery disease undergoing transcatheter aortic valve replacement, revascularization prior to TAVR is recommended for high SYNTAX scores (>22), while decisions for intermediate scores should be individualized.
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