A CTA-first strategy before TAVI yielded similar all-cause mortality compared to an invasive coronary angiography-first strategy (adjusted HR 0.95; 95% CI 0.67-1.34).
Cohort (n=307)
No
Does a CTA-first strategy maintain equivalent all-cause mortality while reducing invasive procedures compared to an ICA-first strategy in patients undergoing TAVI?
A CTA-first strategy for pre-TAVI coronary assessment provides equivalent long-term survival to an ICA-first strategy while safely avoiding invasive angiography in nearly three-quarters of patients.
Hazard Ratio: 0.95 (95% CI 0.67–1.34)
Coronary artery disease is common in patients undergoing transcatheter aortic valve implantation (TAVI), but the optimal pre-procedural coronary assessment strategy is uncertain. We compared long-term outcomes of a computed tomography angiography (CTA)-first versus an invasive coronary angiography (ICA)-first strategy in 307 consecutive patients undergoing TAVI at a single center (ICA-first, n=150; CTA-first, n=157). The primary outcome was all-cause mortality. Over a median follow-up of 61.7 months, mortality did not differ between strategies (unadjusted HR 0.88, 95% CI 0.66-1.16), and assessment strategy was not an independent predictor of death after adjustment (HR 0.95, 95% CI 0.67-1.34). A CTA-first strategy avoided invasive angiography in 73% of patients, with a non-significant trend toward more late post-TAVI catheterization (HR 2.47, 95% CI 0.94-6.45). Pre-TAVI percutaneous coronary intervention was not associated with lower mortality, although coronary artery disease itself identified a higher-risk phenotype. In conclusion, a CTA-first strategy yielded equivalent long-term survival while sparing most patients invasive angiography, supporting its use as the default pre-TAVI coronary assessment strategy.
Garzon et al. (Sat,) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=307). Computed tomography angiography (CTA)-first strategy vs. Invasive coronary angiography (ICA)-first strategy was evaluated on All-cause mortality (HR 0.95, 95% CI 0.67-1.34). A CTA-first strategy before TAVI yielded similar all-cause mortality compared to an invasive coronary angiography-first strategy (adjusted HR 0.95; 95% CI 0.67-1.34).