Impact of Coronary Artery Disease on 30-Day and 1-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-Analysis

Abstract

Background: The impact of coronary artery disease (CAD) on outcomes after transcatheter aortic valve replacement (TAVR) is understudied. Literature on the prognostic role of CAD in the survival of patients undergoing TAVR shows conflicting results. This meta-analysis aims to investigate how CAD impacts patient survival following TAVR.

Methods and results: We completed a comprehensive literature search of Embase, MEDLINE, and the Cochrane Library, and included studies reporting outcome of TAVR based on CAD status of patients for the analysis. From the initial 1631 citations, 15 studies reporting on 8013 patients were analyzed using a random-effects model. Of the 8013 patients undergoing TAVR, with a median age of 81.3 years (79-85.1 years), 46.6% (40-55.7) were men and 3899 (48.7%) had CAD (ranging from 30.8% to 78.2% in various studies). Overall, 3121 SAPIEN/SAPIEN XT/SAPIEN 3 (39.6%) and 4763 CoreValve (60.4%) prostheses were implanted, with transfemoral access being the most frequently used approach for the implantation (76.1%). Our analysis showed no significant difference between patients with and without CAD for all-cause mortality at 30 days post TAVR, with a cumulative odds ratio of 1.07 (95% confidence interval, 0.82-1.40; P=0.62). However, there was a significant increase in all-cause mortality at 1 year in the CAD group compared with patients without CAD, with a cumulative odds ratio of 1.21 (95% confidence interval, 1.07-1.36; P=0.002).

Conclusions: Even though coexisting CAD does not impact 30-day mortality, it does have an impact on 1-year mortality in patients undergoing TAVR. Our results highlight a need to revisit the revascularization strategies for concomitant CAD in patients with TAVR.

Keywords: coronary artery disease; meta‐analysis; revascularization; transcatheter aortic valve implantation; transcatheter aortic valve replacement.

Figure 1

Flow diagram of study selection according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta‐Analyses) statement.

Figure 2

Forest plot comparing risk of 30‐day all‐cause mortality between patients with and without coronary artery disease (CAD). The diamond indicates the overall summary estimate for the analysis. The center of the diamond represents the point estimate and the width represents 95% confidence interval (CI). OR indicates odds ratio.

Figure 3

Forest plot comparing risk of all‐cause mortality at 1 year between patients with and without coronary artery disease (CAD). The diamond indicates the overall summary estimate for the analysis. The center of the diamond represents the point estimate and the width represents 95% confidence interval (CI). OR indicates odds ratio.

Figure 4

Forest plots comparing risk of (A) 30‐day cardiovascular mortality and (B) 30‐day myocardial infarction between patients with and without coronary artery disease (CAD). The diamond indicates the overall summary estimate for the analysis. The center of the diamond represents the point estimate and the width represents 95% confidence interval. OR indicates odds ratio.

Figure 5

Forest plots comparing (A) 30‐day risk of stroke, (B) 30‐day risk of major bleeding, and (C) 30‐day risk of vascular complications between patients with and without coronary artery disease (CAD). The diamond indicates the overall summary estimate for the analysis. The center of the diamond represents the point estimate and the width represents 95% confidence interval (CI). OR indicates odds ratio.

Figure 6

Forest plots comparing (A) 1‐year risk of cardiovascular mortality, (B) 1‐year risk of myocardial infarction, and (C) 1‐year risk of stroke between patients with and without coronary artery disease (CAD). The diamond indicates the overall summary estimate for the analysis. The center of the diamond represents the point estimate and the width represents 95% confidence interval (CI). OR indicates odds ratio.