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March 1, 2018Circulation Cardiovascular Interventions

Complete Revascularization in Patients Before Undergoing Transcatheter Aortic Valve Replacement

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Why the study?

Does complete revascularization before TAVR improve mortality in patients with severe aortic stenosis and concomitant coronary artery disease?

Population

Patients with severe aortic stenosis and concomitant coronary artery disease undergoing transcatheter aortic…

Comparison

Complete or reasonable revascularization before… vs Incomplete revascularization

Design

Editorial

Authors

JSJasmin ShamekhiInterventional / Structural CardiologyJSJan‐Malte SinningInterventional / Structural Cardiology

Discussion

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Implication

Suggests considering more complete pre-TAVR revascularization in severe CAD; leaves open randomized confirmation of mortality benefit.

Structured PICO

Does complete revascularization before TAVR improve mortality in patients with severe aortic stenosis and concomitant coronary artery disease?

P
Population
Patients with severe aortic stenosis and concomitant coronary artery disease undergoing transcatheter aortic valve replacement (TAVR)
I
Intervention
Complete or reasonable revascularization (percutaneous coronary intervention) before TAVR
C
Comparator
Incomplete revascularization
O
Outcome
Mortalityhard clinical

Complete or reasonable revascularization before TAVR may mitigate the increased mortality risk associated with severe concomitant coronary artery disease.

Limitations

  • Inhomogeneous definition of incomplete revascularization
  • Different residual SYNTAX score cut-off values used in the studies

Cite This Study

Shamekhi et al. (2018) studied this question.

synapsesocial.com/papers/6a80e2fc407ce5842fa8a59bhttps://doi.org/10.1161/circinterventions.118.006556

Topics

Coronary artery diseasePercutaneous coronary interventionTranscatheter aortic valve replacementTAVR in low-risk patientsChronic total occlusion PCI
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Impact of coronary artery disease and percutaneous coronary intervention on outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation2011 · 190 citations
  2. 2Severe Aortic Stenosis and Coronary Artery Disease—Implications for Management in the Transcatheter Aortic Valve Replacement Era2013 · 272 citations
  3. 3Percutaneous Coronary Intervention in Patients With Severe Aortic Stenosis2012 · 123 citations
  4. 4Impact of Aortic Valve Stenosis on Coronary Hemodynamics and the Instantaneous Effect of Transcatheter Aortic Valve Implantation2015 · 93 citations
  5. 5Functional Assessment of Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation2016 · 145 citations