Coronary Events After Transcatheter Aortic Valve Replacement: Insights From the France TAVI Registry
- PMID: 39880575
- DOI: 10.1016/j.jcin.2024.09.005
Coronary Events After Transcatheter Aortic Valve Replacement: Insights From the France TAVI Registry
Abstract
Background: The prevalence of coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is high. Treatment of a coronary events (CE) after TAVR can be technically challenging.
Objectives: The authors sought to assess the incidence and prognostic impact of CE after TAVR.
Methods: Patients undergoing TAVR for native aortic stenosis, with balloon-expandable valves (BEV) or self-expandable valves (SEV), included in the France-TAVI registry (Registry of Aortic Valve Bioprostheses Established by Catheter) were studied. The primary endpoint was the rate of first hospitalization for CE at maximal follow-up. The main secondary endpoint was the composite of all-cause mortality or hospitalization for heart failure following CE.
Results: Between 2013 and 2021, 64,660 patients were included (BEV 63.8%, SEV 36.2%). CE occurred in 11.6% of cases (1.5%/y). Previous coronary artery disease and known coronary artery stenosis >50% before TAVR were the main predictors of CE. After CE, the composite endpoint was lower in patients who underwent percutaneous coronary intervention (PCI) compared with those who had only coronary angiography or no intervention (79.6%, 85.2%, and 86.5%, respectively; P = 0.002) and higher in SEV than in BEV patients (85.8% vs 83.8%; P = 0.01). Patients admitted to a TAVR center were more likely to have PCI (OR: 1.20 [95% CI: 1.01-1.42]; P = 0.04), even more so if they had a BEV (OR: 1.42 [95% CI: 1.18-1.71]; P = 0.002).
Conclusions: The yearly incidence of CE after TAVR is low. In the event of CE, patients who have not undergone PCI have a worse outcome. SEV patients have a higher rate of unfavorable outcomes and are less likely to undergo PCI, especially when admitted to non-TAVR centers.
Keywords: TAVR; balloon-expandable valve; coronary artery disease; coronary event(s); percutaneous coronary intervention; self-expandable valve.
Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures This work was supported by the French Society of Cardiology, a grant from Edwards Lifesciences and by the French Government, managed by the National Research Agency (ANR) under the program “Investissements d’Avenir” with the reference ANR-16-RHU-0003-STOP-AS. The data are the property of the French Society of Cardiology and are available on reasonable request. Dr Akodad has been a consultant for Medtronic, Edwards Lifesciences, and Abbott. Dr Dumonteil has received consultancy and proctoring fees from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Cuisset has received minor fees from Abbott Vascular, Boston Scientific, Edwards Lifesciences, Europa organization, Medtronic, Shockwave, Sanofi, and Terumo. Dr Sanguineti has been a consultant for Boston Scientific. Dr Hovasse has been a proctor for Medtronic. Dr Chevalier has been a minor shareholder for Colibri LLC. Dr Neylon has received minor fees from Medtronic, Abbott, and Boston Scientific. Dr Eltchaninoff has received minor fees from Edwards Lifesciences. Dr Garot has been a proctor for Abbott; and has received minor fess from Abbott, Biosensor, Boston Scientific, Cordis, Edwards Lifesciences, General Electric, and Terumo. Dr Benamer has been a proctor for Edwards Lifesciences; and has received minor fees from Abbott, General Electric, Medtronic, Edwards Lifesciences, and Terumo. Dr Lefèvre has been a proctor for Edwards Lifesciences; and has received minor fees from Boston Scientific, Terumo, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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