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Observational Study
. 2023 Sep;102(3):513-520.
doi: 10.1002/ccd.30767. Epub 2023 Jul 20.

Prognostic impact of coronary lesions and its revascularization in a 5-year follow-up after the TAVI procedure

Domingo José López Vázquez  1 , Guillermo Aldama López  1 , Martin Quintas Guzmán  2 , Ariana Varela Cancelo  3 , Fernando Rebollal Leal  1 , Xacobe Flores Rios  1 , Pablo Piñón Esteban  1 , Jorge Salgado Fernandez  1 , Ramón Calviño Santos  1 , José Manuel Vázquez Rodriguez  1
Affiliations
Observational Study

Prognostic impact of coronary lesions and its revascularization in a 5-year follow-up after the TAVI procedure

Domingo José López Vázquez et al. Catheter Cardiovasc Interv. 2023 Sep.

Abstract

Background: Coronary artery disease (CAD) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). However, its prognostic significance and its management remains controversial.

Aims: This study sought to determine whether the presence of CAD, its complexity, and angiography-guided percutaneous coronary intervention (PCI) are associated with outcomes after TAVI.

Methods: All patients undergoing TAVI at a tertiary referral center between 2008 and 2018 were included in a prospective observational study. Baseline SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score (SS) and a residual SS after PCI were calculated. The endpoints on the 5 year follow-up were all-cause mortality and a composite of mayor cardiovascular adverse events (MACE).

Results: In 379 patients, the presence of CAD and its complexity were not significantly associated with worse 5-year survival after TAVI, with a mortality for SS0 of 45%; for SS 1-22 of 36.5% (HR 0.77; 95% CI 0.53-1.11, p = 0.15) and for SS > 22 of 42.1% (HR 1.24; 95% CI 0.59-2.63, p = 0.57). Regarding the combined event of MACE, there were also no statistically significant differences between patients with CAD and without CAD (56.8% in patients without CAD and 54.9% in patients with CAD; HR 1.06; 95% CI 0.79-1.43, p = 0.7). Angiography-guided PCI or completeness of revascularization was not associated with different outcomes.

Conclusions: In the present analysis, neither the presence nor the extent of CAD, nor the degree of revascularization, was associated with a prognostic impact in patients undergoing TAVI at 5-year follow-up.

Keywords: aortic valve disease; coronary artery disease; percutaneous intervention.

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References

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