Key result
The presence and management of obstructive CAD, including pre-TAVI PCI, did not significantly impact 2-year mortality after TAVI (OR 0.631; 95% CI 0.192-1.406), though complex anatomy decreased survival.
Why the study?
Preprocedural evaluation and treatment indications for CAD in patients undergoing TAVI remain controversial.
Does the presence of CAD or pre-TAVI PCI impact 2-year mortality in patients undergoing TAVI?
Cohort (n=379)
No
Does the presence of CAD or pre-TAVI PCI impact 2-year mortality in patients undergoing TAVI?
Odds Ratio: 0.631 (95% CI 0.192–1.406)
In patients undergoing TAVI, the presence of complex coronary artery disease (Syntax Score > 22) is associated with decreased 2-year survival, whereas routine pre-TAVI PCI for obstructive CAD does not appear to improve mortality.
Caution against routine pre-TAVI PCI; leaves open whether Syntax-guided intervention improves outcomes in complex CAD.
OBJECTIVE: Aortic stenosis and coronary artery disease (CAD) are frequently associated. The preprocedural evaluation and indications for treatment in patients undergoing transcatheter aortic valve intervention (TAVI) remain controversial. This study sought to 1) determine the prevalence and angiographic characteristics of CAD in TAVI candidates, along with revascularization patterns, and 2) to evaluate the impact of the presence and complexity of CAD, as well as angiography-guided percutaneous coronary intervention, on prognosis after TAVI. METHODS: Single-center retrospective study from a prospectively collected institutional registry that included all patients that underwent TAVI between 2009 and 2018 and pre TAVI coronary angiography (CA) in our institution in the context of pre-procedure work-up. A multivariate analysis was performed to determine the effect of CAD and PCI on 2-year mortality. RESULTS: A total of 379 patients were included: 55 patients (14.5%) presented with normal coronary arteries, 120 (31.6%) with non-obstructive CAD, and 204 (53.8%) with obstructive CAD (the mean SxS was 8.2). Ultimately, 110 patients (29%) underwent PCI. Two-year survival after TAVI was decreased in patients with complex coronary lesions (SS > 22), while it was not affected by the overall presence of non-obstructive CAD, obstructive CAD, residual SxS, or pre-TAVI PCI of angiographically significant lesions (OR 0.631, 95%CI 0.192-1.406). CONCLUSION: In our population, the overall presence and management of obstructive CAD did not appear to impact mortality at 2 years after TAVI. Survival was decreased in patients with baseline complex coronary anatomies.
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Custódio et al. (2023) conducted a cohort in Aortic stenosis and coronary artery disease (n=379). Obstructive coronary artery disease and pre-TAVI PCI vs. Normal coronary arteries or non-obstructive CAD was evaluated on 2-year mortality (OR 0.631, 95% CI 0.192-1.406). The presence and management of obstructive CAD, including pre-TAVI PCI, did not significantly impact 2-year mortality after TAVI (OR 0.631; 95% CI 0.192-1.406), though complex anatomy decreased survival.
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