Repercusión de la enfermedad coronaria en pacientes con estenosis aórtica severa tratados con la prótesis aórtica percutánea CoreValve

Abstract

BackgroundA third of patients with severe aortic stenosis undergoing valve replacement surgery is associated with coronary heart disease, increasing the risk of surgery. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for patients with severe aortic stenosis and high surgical risk. However, little is known about the effect of coronary artery disease in these patients. The objective was to determine the prevalence and impact having coronary artery disease in patients undergoing percutaneous valve implantation. MethodsBetween April 2008 and December 2011, 230 patients with severe symptomatic aortic stenosis were treated with high surgical risk, with the CoreValve aortic prosthesis. All patients underwent a previous coronary angiography. Results36.1% had coronary artery disease, predominantly male (60%) and greater ventricular dysfunction than patients without coronary disease (24% vs. 12%, P=.02). There was no difference in hospital mortality (4.1% vs. 7.2%, P=.303) when comparing patients with and without coronary disease. Survival at 12 and 24months was slightly lower in patients with coronary artery disease (80.9% vs. 91.4% and 72.6% vs. 86.5%, P=.048, respectively). The revascularized coronary patients previously had a slightly higher survival non-revascularized patients, 82.9% vs. 78.6% at 12 months and 67.2% vs. 61.15% at 24 months, P=.63. ConclusionsThe treatment of coronary artery disease in patients with severe aortic stenosis prior to percutaneous implantation of CoreValve aortic prosthesis improves the prognosis of these short and medium term.