Abstract
Background: Significant coronary artery disease (CAD) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). Assessment of CAD prior to TAVI is recommended by current guidelines and is mainly performed via invasive coronary angiography (ICA). In this study we analyzed the ability of coronary CT-angiography (cCTA) to rule out significant CAD (stenosis ≥ 50%) during routine pre-TAVI evaluation in patients with high pre-test probability for CAD. Methods: In total, 460 consecutive patients undergoing pre-TAVI CT (mean age 79.6 ± 7.4 years) were included. All patients were examined with a retrospectively ECG-gated CT-scan of the heart, followed by a high-pitch-scan of the vascular access route utilizing a single intravenous bolus of 70 mL iodinated contrast medium. Images were evaluated for image quality, calcifications, and significant CAD; CT-examinations in which CAD could not be ruled out were defined as positive (CAD+). Routinely, patients received ICA (388/460; 84.3%; Group A), which was omitted if renal function was impaired and CAD was ruled out on cCTA (Group B). Following TAVI, clinical events were documented during the hospital stay. Results: cCTA was negative for CAD in 40.2% (188/460). Sensitivity, specificity, PPV, and NPV in Group A were 97.8%, 45.2%, 49.6%, and 97.4%, respectively. Median coronary artery calcium score (CAC) was higher in CAD+-patients but did not have predictive value for correct classification of patients with cCTA. There were no significant differences in clinical events between Group A and B. Conclusion: cCTA can be incorporated into pre-TAVI CT-evaluation with no need for additional contrast medium. cCTA may exclude significant CAD in a relatively high percentage of these high-risk patients. Thereby, cCTA may have the potential to reduce the need for ICA and total amount of contrast medium applied, possibly making pre-procedural evaluation for TAVI safer and faster.
Highlights
Transcatheter aortic valve implantation (TAVI) has become the standard method to treat patients with severe aortic stenosis who cannot undergo surgical aortic valve replacement and has evolved into an established option in patients who can undergo surgery [1,2,3,4]
In this study we analyzed the ability of coronary CT-angiography to rule out significant coronary artery disease (CAD) during routine pre-transcatheter aortic valve implantation (TAVI) evaluation in patients with high pre-test probability for CAD
Forty-four patients were excluded because of prior coronary artery bypass grafting (CABG) (n = 37) or non-retrospectively gated CT-acquisition (n = 7) (Figure 1). Another 13 patients were excluded as CAD could not be ruled out on coronary CT-angiography (cCTA) and invasive coronary angiography (ICA) was not performed within 3 months of the CT-examination (n = 5) or quantitative assessment of coronary arteries (QCA) (n = 8) was not possible with the available data (Figure 1)
Summary
Transcatheter aortic valve implantation (TAVI) has become the standard method to treat patients with severe aortic stenosis who cannot undergo surgical aortic valve replacement and has evolved into an established option in patients who can undergo surgery [1,2,3,4]. Patients currently treated with TAVI are commonly elderly, frail, and have a high prevalence of co-morbidities including chronic kidney and coronary artery disease (CAD) [3,4]. The latter is recommended to be assessed by invasive coronary angiography (ICA) prior to TAVI. In this study we analyzed the ability of coronary CT-angiography (cCTA) to rule out significant CAD (stenosis ≥ 50%) during routine pre-TAVI evaluation in patients with high pre-test probability for CAD. Thereby, cCTA may have the potential to reduce the need for ICA and total amount of contrast medium applied, possibly making pre-procedural evaluation for TAVI safer and faster
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
