Impact of coronary artery disease in patients undergoing transcatheter aortic valve replacement: Insights from the FRANCE-2 registry

Abstract

To assess the long term clinical impact of coronary artery disease (CAD) distribution in patients undergoing transcatheter aortic valve replacement (TAVR) using the FRench Aortic National CoreValve and Edwards (FRANCE-2) registry. CAD is common in patients undergoing TAVR. However, the impact of CAD distribution before TAVR on short and long-term prognosis remains unclear. FRANCE-2 is a national French registry including all consecutive TAVR performed between 2010 and 2012 in 34 centres. Three-year mortality was assessed in relation to CAD status. CAD was define as at least one coronary stenosis > 50%. A total of 4201 patients were enrolled in the registry. For the present analysis, we excluded patients with a history of coronary artery bypass. CAD was reported in 1252 patients (30%). Half of patient presented with coronary multivessel disease. CAD extent was associated with an increase in cardiovascular risk-profile and in Logistic Euroscore (from 19.3 ± 12.8% to 21.9 ± 13.5%, P < 0.001). Mortality at 30 days and 3 years was 9% and 44% respectively in the overall population. In multivariate analyses, neither the presence nor the extent of CAD was associated with mortality at 3 years (presence of CAD: HR 0.90; 95% CI 0.78 to 1.07). Significant lesion of the left anterior descending (LAD) was associated with higher 3-year mortality (HR 1.42; 95% CI 1.10 to 1.87). Similar results were found after propensity score matching (428 patients per group). CAD is not associated with decreased short and long-term survival in patients undergoing TAVR. The potential deleterious effect of LAD disease on long-term survival suggests the need for revascularization before or at the time of TAVR.