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Impact of untreated CAD on TAVR outcomes

29 Jan 2024
Coronary Artery Disease in Transcatheter Aortic Valve Replacement

The optimal management of concomitant chronic obstructive coronary artery disease (CAD) in transcatheter aortic valve replacement (TAVR) recipients remains a debated topic. While some advocate for pre-TAVR percutaneous coronary intervention, others adopt an expectant approach. In a recent study published in the European Heart Journal, researchers investigated the influence of varying degrees and extent of untreated chronic obstructive CAD on TAVR outcomes and longer-term results.

Conducted as a retrospective cohort study from January 2015 to November 2021, TAVR recipients were categorized based on the presence of stable non-obstructive or varying degrees of obstructive CAD. Major outcomes included procedural all-cause mortality and complications, major adverse cardiovascular events, and post-TAVR unplanned coronary revascularization.

Among the 1911 patients meeting inclusion criteria, 75%, 6%, 10%, and 9% had non-obstructive, intermediate-risk, high-risk, and extreme-risk CAD, respectively. Procedural complication rates were generally low, with no significant differences across groups. At a median follow-up of 21 months, rates of acute coronary syndrome and unplanned coronary revascularization increased with the severity of CAD. However, multivariable analysis did not reveal a significantly greater risk of all-cause mortality or major adverse cardiovascular events across groups. Time-to-event analyses showed significantly greater one-year acute coronary syndrome and unplanned coronary revascularization rates in the non-obstructive subset compared to the obstructive subset.

The authors concluded that transcatheter aortic valve replacement can be safely performed in patients with untreated chronic obstructive CAD, demonstrating comparable procedural complication rates and relatively low rates of unplanned coronary revascularization and acute coronary syndrome at one year.

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Original article:

Persits I et al. European Heart Journal 2024.

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