Optimized Screening of Coronary Artery Disease With Invasive Coronary Angiography and Ad Hoc Percutaneous Coronary Intervention During Transcatheter Aortic Valve Replacement

Marco Barbanti; Denise Todaro; Giuliano Costa; Gerlando Pilato; Andrea Picci; Simona Gulino; Piera Capranzano; Ketty La Spina; Emanuela Di Simone; Paolo D'Arrigo; Wanda Deste; Antonino Indelicato; Stefano Cannata; Daniela Giannazzo; Sebastiano Immè; Claudia Tamburino; Martina Patanè; Sergio Buccheri; Davide Capodanno; Carmelo Sgroi; Corrado Tamburino

doi:10.1161/CIRCINTERVENTIONS.117.005234

Optimized Screening of Coronary Artery Disease With Invasive Coronary Angiography and Ad Hoc Percutaneous Coronary Intervention During Transcatheter Aortic Valve Replacement

Circ Cardiovasc Interv. 2017 Aug;10(8):e005234. doi: 10.1161/CIRCINTERVENTIONS.117.005234.

Authors

Marco Barbanti¹, Denise Todaro², Giuliano Costa², Gerlando Pilato², Andrea Picci², Simona Gulino², Piera Capranzano², Ketty La Spina², Emanuela Di Simone², Paolo D'Arrigo², Wanda Deste², Antonino Indelicato², Stefano Cannata², Daniela Giannazzo², Sebastiano Immè², Claudia Tamburino², Martina Patanè², Sergio Buccheri², Davide Capodanno², Carmelo Sgroi², Corrado Tamburino²

Affiliations

¹ From the Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., D.T., G.C., G.P., A.P., S.G., P.C., K.L.S., E.D.S., P.D., W.D., A.I., S.C., D.G., S.I., C.T., M.P., S.B., D.C., C.S., C.T.); and ETNA Foundation, Catania, Italy (C.T.). mbarbanti83@gmail.com.
² From the Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., D.T., G.C., G.P., A.P., S.G., P.C., K.L.S., E.D.S., P.D., W.D., A.I., S.C., D.G., S.I., C.T., M.P., S.B., D.C., C.S., C.T.); and ETNA Foundation, Catania, Italy (C.T.).

PMID: 28768757
DOI: 10.1161/CIRCINTERVENTIONS.117.005234

Abstract

Background: We sought to describe an optimized approach to coronary artery disease (CAD) screening and management in patients undergoing transcatheter aortic valve replacement (TAVR).

Methods and results: When invasive coronary angiography showed CAD, the treatment strategy and completeness of revascularization was determined based on coronary anatomy. TAVR was performed in the same setting if percutaneous coronary intervention (PCI) was uncomplicated; otherwise TAVR was postponed. A total of 604 patients undergoing CAD screening at the time of TAVR procedure were prospectively included in this study. Severe CAD was found in 136 patients (22.5%). Among patients with severe CAD, 53 patients (8.8%) underwent uncomplicated PCI. After PCI, TAVR was postponed in 2 patients (0.3%). In 83 patients (13.8%), coronary angiography showed severe CAD that was left untreated. After TAVR, all-cause and cardiovascular 30-day mortality rates were 2.4% and 1.4%, respectively. Disabling stroke, myocardial infarction, and life-threatening bleeding occurred in 0.5%, 0.8%, and 4.0% of patients, respectively. Acute kidney injury II or III rate was 3.3%. At 2 years, all-cause mortality rate was 14.1%. Disabling stroke and myocardial infarction occurred in 2.5% and 1.8% of patients, respectively. Patients undergoing TAVR and PCI in the same session had similar rate of the composite of death, disabling stroke, and myocardial infarction when compared with patients without CAD, and patients with severe CAD left untreated (TAVR+PCI: 10.4%; severe CAD left untreated: 15.4%; no-CAD: 14.8%; P=0.765).

Conclusions: In patients undergoing TAVR, screening of CAD with invasive coronary angiography and ad hoc PCI during TAVR is feasible and was not associated with increased periprocedural risks. PCI followed by TAVR in the same session had similar outcomes than TAVR in which PCI was not performed.

Keywords: acute kidney injury; aortic valve stenosis; coronary angiography; coronary artery disease; myocardial infarction; stroke.

MeSH terms

Aged
Aged, 80 and over
Coronary Angiography / statistics & numerical data*
Coronary Artery Disease / diagnosis*
Coronary Artery Disease / therapy
Female
Humans
Male
Mass Screening / statistics & numerical data*
Percutaneous Coronary Intervention / statistics & numerical data*
Transcatheter Aortic Valve Replacement / statistics & numerical data*