Scripties UMCG - Rijksuniversiteit Groningen
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The effect of coronary artery disease and pre-procedural percutaneous coronary intervention on the mortality after TAVI: the location of significant stenosis is more important than the extent of the disease

(2019) Gunster, J.

Background: Coronary artery disease (CAD) is a common concurrent condition in patients with severe aortic stenosis (AS). Previous research has shown controversial results on the prognostic implications and pre-procedural treatment of CAD in AS patients who are undergoing transcatheter aortic valve implantation (TAVI). With treatment paradigms shifting to a wider application of TAVI, clarification on the role of CAD and the necessity of pre-procedural treatment in these patients is essential. Objectives: The primary aim of this study was to determine prognostic implications of the extent and location of CAD on the all-cause mortality after TAVI. The secondary aim was to display which coronary segments were treated most often in the local TAVI database and what the influence of percutaneous coronary intervention (PCI) was on the all-cause mortality after TAVI. Methods: We retrospectively analyzed the coronary angiography reports of 1,423 AS patients that underwent TAVI in the Amsterdam UMC. Survival analysis at 0.5 and 1 year was performed by Kaplan Meier and Cox regression analysis to explore the effect size of the tested predictors on the survival after TAVI. Results: CAD was present in over the half of the cohort (55%). There was no significant effect of the extent of CAD on 0.5 and 1 year mortality after adjustment for confounders (p=0.106, p=0.119). Significant stenosis in the LAD trajectory was associated with higher mortality at 0.5 year in multivariate analysis (HR 2.26, 95% CI 1.28-4.01, p=0.005). PCI in significant lesions was associated with higher mortality at 0.5 year (p=0.01). Conclusions: Significant CAD in the LAD trajectory is associated with higher mortality at short-term follow-up after TAVI. Pre-procedural PCI of significant lesions tended to worsen short-term survival after TAVI.

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