Significant coronary artery disease is present in 40% to 75% of patients undergoing TAVR, though existing data suggest not all patients require revascularization before the procedure.
How should coronary artery disease be managed in patients with severe aortic stenosis undergoing TAVR?
In patients undergoing TAVR, CAD is highly prevalent (40-75%), but routine revascularization is not required for all patients; PCI should be reserved for severe proximal lesions.
Management of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR) is posing challenges. Due to limited and heterogeneous data on the prevalence and clinical impact of CAD on the outcomes of TAVR and the management strategies for CAD in patients undergoing TAVR, we performed a comprehensive review of the literature. Significant CAD is present in 40% to 75% of patients undergoing TAVR. The impact of CAD on outcomes after TAVR remains understudied. Based on existing data, not all patients require revascularization before TAVR. Percutaneous coronary intervention (PCI) should be considered for severely stenotic lesions in proximal coronaries that subtend a large area of myocardium at risk. Ongoing studies randomizing patients to surgical or percutaneous management strategies for severe AS will help provide valuable data regarding the impact of CAD on TAVR outcomes, the role of PCI, and its timing in relation to TAVR.
Goel et al. (Wed,) conducted a review in Severe aortic stenosis and coronary artery disease. Percutaneous coronary intervention was evaluated. Significant coronary artery disease is present in 40% to 75% of patients undergoing TAVR, though existing data suggest not all patients require revascularization before the procedure.