Abstract
Background: The impact of coronary artery disease (CAD) and revascularization by percutaneous coronary intervention (PCI) on prognosis in patients undergoing transcatheter aortic valve replacement (TAVR) remain debated. A dismal prognosis in patients undergoing PCI has been associated with elevated baseline SYNTAX score (bSS) and residual SYNTAX score (rSS). The objective was to investigate whether the degree of bSS and rSS impacted ischemic and bleeding events after TAVR. Methods: bSS and rSS were calculated in 311 patients admitted for TAVR. The primary outcome was the occurrence of major adverse cardiac events (MACE), a composite endpoint of myocardial infarction, stroke, cardiovascular death, or rehospitalization for heart failure. The occurrence of late major/life-threatening bleeding complications (MLBCs) and each primary endpoint individually were the secondary endpoints. Results: bSS > 22 was associated with higher occurrence of MACE (p = 0.013). rSS > 8 and bSS > 22 had no impact on overall cardiovascular mortality. rSS > 8 and bSS > 22 were associated with higher rates of myocardial infarction (p = 0.001 and p = 0.004) and late occurrence of MLBCs. Multivariate analysis showed that bSS > 22 (sHR 2.48) and rSS > 8 (sHR 2.35) remained predictors of MLBCs but not of myocardial infarction. Conclusions: Incomplete coronary revascularization and CAD burden did not impact overall and cardiac mortality but constitute predictors of late MLBCs in TAVR patients.
Highlights
In elderly population, aortic stenosis (AS) coexists with significant coronary artery disease (CAD) in up to 50% of the cases and both diseases share common pathophysiological pattern associated with ageing including oxidative stress, endothelial dysfunction, enhanced inflammation, diabetes mellitus, or chronic kidney disease [1,2,3,4]
In patients scheduled for transcatheter aortic valve replacement (TAVR) procedures, current European Society of Cardiology (ESC) guidelines for myocardial revascularization suggest that percutaneous coronary intervention (PCI) should be considered before the index procedure in case of a coronary artery diameter stenosis of >70% affecting a proximal segment [6]
The evidence basis for such method remains limited and the impact of incomplete revascularization remains poorly investigated. In this frail population characterized by a high bleeding risk, the noxious impact of subsequent antithrombotic therapies associated to PCI on bleedings events remains unexplored
Summary
Aortic stenosis (AS) coexists with significant coronary artery disease (CAD) in up to 50% of the cases and both diseases share common pathophysiological pattern associated with ageing including oxidative stress, endothelial dysfunction, enhanced inflammation, diabetes mellitus, or chronic kidney disease [1,2,3,4]. In patients scheduled for transcatheter aortic valve replacement (TAVR) procedures, current European Society of Cardiology (ESC) guidelines for myocardial revascularization suggest that percutaneous coronary intervention (PCI) should be considered before the index procedure in case of a coronary artery diameter stenosis of >70% affecting a proximal segment [6]. The evidence basis for such method remains limited and the impact of incomplete revascularization remains poorly investigated In this frail population characterized by a high bleeding risk, the noxious impact of subsequent antithrombotic therapies associated to PCI on bleedings events remains unexplored. The impact of coronary artery disease (CAD) and revascularization by percutaneous coronary intervention (PCI) on prognosis in patients undergoing transcatheter aortic valve replacement (TAVR) remain debated. Conclusions: Incomplete coronary revascularization and CAD burden did not impact overall and cardiac mortality but constitute predictors of late MLBCs in TAVR patients
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