Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation

Giulio G Stefanini; Stefan Stortecky; Davide Cao; Julie Rat-Wirtzler; Crochan J O'Sullivan; Steffen Gloekler; Lutz Buellesfeld; Ahmed A Khattab; Fabian Nietlispach; Thomas Pilgrim; Christoph Huber; Thierry Carrel; Bernhard Meier; Peter Jüni; Peter Wenaweser; Stephan Windecker

doi:10.1093/eurheartj/ehu074

Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation

Eur Heart J. 2014 Oct 1;35(37):2530-40. doi: 10.1093/eurheartj/ehu074. Epub 2014 Mar 28.

Authors

Giulio G Stefanini¹, Stefan Stortecky¹, Davide Cao¹, Julie Rat-Wirtzler², Crochan J O'Sullivan¹, Steffen Gloekler¹, Lutz Buellesfeld¹, Ahmed A Khattab¹, Fabian Nietlispach¹, Thomas Pilgrim¹, Christoph Huber³, Thierry Carrel³, Bernhard Meier¹, Peter Jüni², Peter Wenaweser⁴, Stephan Windecker¹

Affiliations

¹ Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
² CTU Bern, Department of Clinical Research, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
³ Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland.
⁴ Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland peter.wenaweser@insel.ch.

PMID: 24682843
DOI: 10.1093/eurheartj/ehu074

Abstract

Aim: The aim of this study was to evaluate whether coronary artery disease (CAD) severity exerts a gradient of risk in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).

Methods and results: A total of 445 patients with severe AS undergoing TAVI were included into a prospective registry between 2007 and 2012. The preoperative SYNTAX score (SS) was determined from baseline coronary angiograms. In case of revascularization prior to TAVI, residual SS (rSS) was also determined. Clinical outcomes were compared between patients without CAD (n = 158), patients with low SS (0-22, n = 207), and patients with high SS (SS > 22, n = 80). The pre-specified primary endpoint was the composite of cardiovascular death, stroke, or myocardial infarction (MI). At 1 year, CAD severity was associated with higher rates of the primary endpoint (no CAD: 12.5%, low SS: 16.1%, high SS: 29.6%; P = 0.016). This was driven by differences in cardiovascular mortality (no CAD: 8.6%, low SS: 13.6%, high SS: 20.4%; P = 0.029), whereas the risk of stroke (no CAD: 5.1%, low SS: 3.3%, high SS: 6.7%; P = 0.79) and MI (no CAD: 1.5%, low SS: 1.1%, high SS: 4.0%; P = 0.54) was similar across the three groups. Patients with high SS received less complete revascularization as indicated by a higher rSS (21.2 ± 12.0 vs. 4.0 ± 4.4, P < 0.001) compared with patients with low SS. High rSS tertile (> 14) was associated with higher rates of the primary endpoint at 1 year (no CAD:12.5%, low rSS: 16.5%, high rSS: 26.3%, P = 0.043).

Conclusions: Severity of CAD appears to be associated with impaired clinical outcomes at 1 year after TAVI. Patients with SS > 22 receive less complete revascularization and have a higher risk of cardiovascular death, stroke, or MI than patients without CAD or low SS.

Keywords: Aortic stenosis; Coronary artery disease; SYNTAX score; Transcatheter aortic valve implantation.

Publication types

Observational Study

MeSH terms

Aged, 80 and over
Aortic Valve Stenosis / complications
Aortic Valve Stenosis / mortality
Aortic Valve Stenosis / pathology
Aortic Valve Stenosis / surgery*
Coronary Artery Disease / complications*
Coronary Artery Disease / mortality
Coronary Artery Disease / pathology
Female
Heart Valve Prosthesis
Humans
Male
Myocardial Infarction / etiology
Prospective Studies
Severity of Illness Index
Stroke / etiology
Transcatheter Aortic Valve Replacement / instrumentation
Transcatheter Aortic Valve Replacement / methods*
Transcatheter Aortic Valve Replacement / mortality
Treatment Outcome