Clinical outcomes of physiology-guided coronary revascularization in patients undergoing TAVR

Abstract

Abstract Background Coronary artery disease frequently coexists with severe aortic valve stenosis (AS). Although an fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in native coronary artery has been shown to be associated with better clinical outcomes as compared with an angiography-guided PCI, it is unknown whether this applies to severe AS patients. Purpose The purpose of this study was to compare the outcomes of different revascularization strategies between FFR-guided and angiography-guided PCI in AS patients undergoing transcatheter aortic valve replacement (TAVR). Methods In this retrospective analysis, we included 401 patients with severe AS undergoing TAVR who had coexisting coronary artery disease at invasive coronary angiography. A total of 156 patients was considered to have significant coronary artery lesions (>50% of diameter stenosis) due to the visual estimation. Patients were divided into 2 groups: physiology-guided (n=96, PCI performed in case of FFR ≤0.80 or diameter stenosis ≥90%) and angiography-guided PCI (n=60, PCI performed based on angiographic evaluation). Patients were clinically followed up and evaluated for the occurrence of major adverse cardiac and cerebrovascular event (MACCE; defined as a composite of death, non-fatal myocardial infarction, target vessel failure, and cerebrovascular accident) and major bleeding event defined as ≥VARC-3 type 2. Results Most lesions (62/96; 65%) in the physiology-guided group had negative results and were deferred. During a median follow-up of 743 [from 400 to 1,186] days, physiology-guided group had a significantly lower rate of MACCE compared with the angiography-guided groups (adjusted hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.20-0.83; P<0.01). In addition, physiology-guided group showed a lower major bleeding event rate compared with the angiography-guided group (adjusted HR, 0.12; 95% CI, 0.04-0.40; P<0.01). Conclusion Physiology-guided PCI resulted in better clinical outcomes and lower bleeding events than angiography-guided PCI in patients with AS undergoing TAVR.