Key result
Selective pre-TAVI coronary angiography proves feasible and safe, with flow-limiting lesions only increasing repeat CA.
Why the study?
The clinical value of routine coronary angiogram before TAVI is uncertain given that pre-TAVI coronary revascularisation was not associated with improved outcomes.
Does a selective approach to pre-TAVI coronary angiogram affect clinical outcomes in patients undergoing TAVI?
Cohort
No
Does a selective approach to pre-TAVI coronary angiogram affect clinical outcomes in patients undergoing TAVI?
p-value: p=0.007
A selective approach to pre-TAVI coronary angiography is feasible and safe, suggesting routine angiography may not be necessary.
Selective pre-TAVI angiography may be feasible in select patients; leaves open whether routine use can be omitted without randomized confirmation.
BACKGROUND: Coexistent coronary artery disease is commonly seen in patients undergoing transcatheter aortic valve implantation (TAVI). Previous studies showed that pre-TAVI coronary revascularisation was not associated with improved outcomes, challenging the clinical value of routine coronary angiogram (CA). AIM: To assess whether a selective approach to perform pre-TAVI CA is safe and feasible. METHODS: This was a retrospective non-randomised single-centre analysis of consecutive patients undergoing TAVI. A selective approach for performing CA tailored to patient clinical need was developed. Clinical outcomes were compared based on whether patients underwent CA. The primary endpoint was a composite of all-cause mortality, myocardial infraction, repeat CA, and re-admission with heart failure. RESULTS: = 0.007). In those who underwent CA, the presence of flow limiting lesions did not affect the incidence of primary endpoint, or its components, except for increased rate of repeat CA. CONCLUSION: Selective CA is a feasible and safe approach. The clinical value of routine CA should be challenged in future randomised trials.
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Beska et al. (2021) conducted a cohort in Transcatheter aortic valve implantation (TAVI). Selective coronary angiogram (CA) vs. No coronary angiogram was evaluated on Composite of all-cause mortality, myocardial infraction, repeat CA, and re-admission with heart failure (p=0.007). A selective approach to pre-TAVI coronary angiography was feasible and safe, with flow-limiting lesions not affecting the primary composite endpoint except for increased repeat CA.
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