Key result
This review summarizes evidence on the optimal timing and treatment modalities for percutaneous coronary interventions in patients with severe aortic stenosis and coronary artery disease undergoing TAVI.
This review summarizes the evidence and guidelines for managing coexisting coronary artery disease in patients undergoing TAVI, highlighting the recommendation for PCI in proximal stenosis >70%.
Offers synthesized guidance for CAD in TAVI; leaves open need for RCTs on optimal PCI timing.
Coronary artery disease (CAD) and aortic valve stenosis (AS) are frequently coexisting. It has been reported that CAD is present in 40% of patients with AS undergoing surgical aortic valve replacement, and in up to 60% of patients with AS undergoing transcatheter aortic valve implantation (TAVI). Elderly patients with CAD and AS are characterised by higher baseline risk profiles as compared to patients with isolated AS, increasing the complexity of their therapeutic management. In patients with CAD and AS the combination of coronary artery bypass grafting (CABG) and surgical aortic valve replacement has been shown to improve survival. Therefore, CABG is recommended in patients with CAD and AS undergoing surgical aortic valve replacement according to current guidelines of the European Society of Cardiology (ESC) and of the American College of Cardiology Foundation/American Heart Association (ACCF/AHA). Conversely, whether the presence of CAD has any prognostic implications in elderly patients with severe AS undergoing TAVI is still a matter of debate. Of note, according to the most recent ESC guidelines on myocardial revascularisation, percutaneous revascularisation should be considered in patients undergoing TAVI with a stenosis >70% in proximal coronary segments (class IIa, level of evidence C). The aim of this article is to provide an overview of evidence supporting the need for coronary revascularisation in patients with severe AS and CAD undergoing TAVI, and to summarise optimal timing and treatment modalities for percutaneous coronary interventions in these patients.
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Stefanini et al. (2014) conducted a review in Coronary artery disease and severe aortic stenosis undergoing TAVI. Percutaneous coronary intervention was evaluated. This review summarizes evidence on the optimal timing and treatment modalities for percutaneous coronary interventions in patients with severe aortic stenosis and coronary artery disease undergoing TAVI.
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