Key result
Coexisting chronic total occlusion did not significantly increase all-cause mortality (RR 1.21) but was associated with higher risks of in-hospital mortality, acute myocardial infarction, and acute kidney injury.
Why the study?
Chronic total occlusion may negatively impact outcomes in patients undergoing TAVR, but data evaluating this relationship are limited.
Does the presence of chronic total occlusion increase adverse cardiovascular outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement?
Meta-Analysis (n=331,249)
Does the presence of chronic total occlusion increase adverse cardiovascular outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement?
Relative Risk: 1.21 (95% CI 0.76–1.93)
p-value: p=0.42
In patients undergoing TAVR, concurrent chronic total occlusion does not significantly affect all-cause mortality but increases the risk of in-hospital mortality, myocardial infarction, and procedural complications.
Background: Transcatheter aortic valve replacement (TAVR) has significantly advanced the treatment of severe aortic stenosis (AS), particularly in elderly patients who often have coexisting coronary artery disease (CAD). Chronic total occlusion (CTO), a severe form of CAD, may negatively impact outcomes in TAVR patients, though data are limited. This meta-analysis aims to evaluate the impact of CTO on TAVR outcomes. Methods: A comprehensive literature search was conducted across multiple electronic databases to identify studies comparing TAVR outcomes in patients with and without CTO. Pooled risk ratios (RR) with 95 % confidence intervals (CIs) were calculated using a random-effects model. The primary outcome was all-cause mortality, with several secondary endpoints also assessed. Results: Six studies involving a total of 331,159 TAVR patients were included in this meta-analysis. CTO was associated with a significantly increased risk of in-hospital mortality (RR: 1.24; 95 % CI: 1.01, 1.52; p = 0.04), acute myocardial infarction (RR: 1.67; 95 % CI: 1.48, 1.89; p < 0.00001), acute kidney injury (RR: 1.46; 95 % CI: 1.37, 1.56; p < 0.00001), and vascular complications (RR: 1.47; 95 % CI: 1.28, 1.69; p < 0.00001). No significant differences were observed in all-cause mortality (RR: 1.21; 95 % CI: 0.76, 1.93; p = 0.42), stroke (RR: 1.09; 95 % CI: 0.91, 1.30; p = 0.37), or bleeding events (RR: 1.19; 95 % CI: 1.00, 1.41; p = 0.06). Conclusion: CTO poses a significant risk in TAVR patients, particularly for in-hospital mortality and acute myocardial infarction. A multidisciplinary approach is recommended for these patients, with consideration given to revascularization before TAVR. Further studies are needed to evaluate the potential benefits of prior CTO-PCI.
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Goyal et al. (2024) conducted a meta-analysis in Severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) (n=331,249). Chronic total occlusion (CTO) vs. Absence of chronic total occlusion was evaluated on All-cause mortality (RR 1.21, 95% CI 0.76, 1.93, p=0.42). Coexisting chronic total occlusion did not significantly increase all-cause mortality (RR 1.21) but was associated with higher risks of in-hospital mortality, acute myocardial infarction, and acute kidney injury.
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