Impact of Chronic Coronary Artery Disease and Revascularization Strategy in Patients with Severe Aortic Stenosis Who Underwent Transcatheter Aortic Valve Implantation

Cristina Aurigemma; Mauro Massussi; Chiara Fraccaro; Marianna Adamo; Paola D'Errigo; Stefano Rosato; Fulvia Seccareccia; Gennaro Santoro; Massimo Baiocchi; Marco Barbanti; Fausto Biancari; Giovanni Baglio; Andrea Marcellusi; Carlo Trani; Giuseppe Tarantini; OBSERVANT II Research Group

doi:10.1016/j.amjcard.2023.08.045

Impact of Chronic Coronary Artery Disease and Revascularization Strategy in Patients with Severe Aortic Stenosis Who Underwent Transcatheter Aortic Valve Implantation

Am J Cardiol. 2023 Nov 1:206:14-22. doi: 10.1016/j.amjcard.2023.08.045. Epub 2023 Sep 5.

Authors

Affiliations

¹ Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.
² Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
³ Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
⁴ National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy.
⁵ Fondazione "G. Monasterio" CNR/Regione Toscana per la Ricerca Medica e la Sanità Pubblica, Massa, Italy.
⁶ Policlinico Sant'Orsola, Bologna, Italy.
⁷ Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy.
⁸ Department of Internal Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
⁹ Italian National Agency for Regional Healthcare Services, Rome, Italy.
¹⁰ Economic Evaluation and HTA (EEHTA-CEIS), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.
¹¹ Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy. Electronic address: carlotrani@gmail.com.

PMID: 37677878
DOI: 10.1016/j.amjcard.2023.08.045

Abstract

The prognostic impact of coronary artery disease (CAD) after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study is to investigate the impact of CAD and different revascularization strategies on clinical outcomes in patients who underwent TAVI with third generation devices. Patients enrolled in the national observational Observational Study of Effectiveness of SAVR-TAVI Procedures for Severe Aortic Stenosis Treatment II study were stratified according to the presence of CAD (CAD+, n = 1,130) versus no CAD (CAD-, n = 1,505), and compared using a propensity matched analysis. CAD+ group was further stratified according to the revascularization strategy: no revascularization (n = 331), revascularization performed >90 days before index-TAVI (n = 417) and coronary revascularization performed <90 days before index-TAVI or during TAVI (n = 382). In-hospital, 30-day and 1-year clinical outcomes were estimated. The mean age of the overall population was 81.8 years; 54.9% of patients were female. Propensity score matching yielded 813 pairs and their 30-day all-cause mortality was comparable (p = 0.480). Major periprocedural adverse events were also similar between the groups. At 1-year follow-up, the rate of major adverse cardiac and cerebrovascular events (MACCEs) and all-cause mortality were similar between the groups (p = 0.732 and p = 0.633, respectively). Conversely, patients with CAD experienced more often myocardial infarction and need for percutaneous coronary intervention at 1 year (p = 0.007 and p = 0.001, respectively). Neither CAD nor revascularization strategy were independent predictors of 1-year MACCE. About 40% of patients presenting with severe AS and who underwent TAVI had concomitant CAD. The presence of CAD had no impact on all-cause mortality and MACCE 1-year after TAVR. However, CAD carries a higher risk for acute myocardial infarction and need of percutaneous coronary intervention during follow-up.

Keywords: aortic stenosis; coronary artery disease; percutaneous coronary intervention; transcatheter aortic valve replacement.