Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement

Jun Li, Sandeep M. Patel, Fahd Nadeem, Prashanth Thakker, Sadeer Al-Kindi, Rahul Thomas, Amber Makani, John M. Hornick, Toral Patel, Jerry Lipinski, Yasuhiro Ichibori, Angela Davis, Alan H. Markowitz, Hiram G. Bezerra, Daniel I. Simon, Marco A. Costa, Ankur Kalra, Guilherme F. Attizzani

Research output: Contribution to journalArticle

Abstract

Objectives: This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). Background: There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. Methods: Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor). When feasible, SYNTAX scoring was performed for exploratory analysis. Analyses were performed using Cox proportional hazard models and Kaplan–Meier method. Results: A total of 323 patients with active CAD were included. Adjusted outcomes showed that patients with IR Major had increased incidence of acute myocardial infarction (AMI) or revascularization compared with those in the CR cohort (HR 3.72, P = 0.048). No difference was noted in all-cause mortality or all-cause readmission rates. Exploratory secondary analysis with residual SYNTAX scores showed a significant interaction between disease burden and AMI/revascularization, as well as all-cause readmission. All-cause mortality remained unaffected based on residual SYNTAX scores. Conclusions: This is a retrospective single-center study reporting on pre-TAVR revascularization outcomes in patients with active CAD. In this analysis, we found that patients undergoing TAVR benefited from achieving complete revascularization to abate future incidence of AMI/revascularization. Despite this finding, all-cause mortality remained unaffected. Future efforts should focus on the role of functional assessment of the coronaries, as well as the long-term effects of complete revascularization in a larger patient cohort.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2018

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Coronary Artery Disease
Myocardial Revascularization
Myocardial Infarction
Mortality
Arteries
Incidence
Acute Disease
Transcatheter Aortic Valve Replacement
Proportional Hazards Models

Keywords

  • AVD - aortic valve disease
  • CAD - coronary artery disease
  • PCI - percutaneous coronary intervention (PCI)
  • percutaneous intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement. / Li, Jun; Patel, Sandeep M.; Nadeem, Fahd; Thakker, Prashanth; Al-Kindi, Sadeer; Thomas, Rahul; Makani, Amber; Hornick, John M.; Patel, Toral; Lipinski, Jerry; Ichibori, Yasuhiro; Davis, Angela; Markowitz, Alan H.; Bezerra, Hiram G.; Simon, Daniel I.; Costa, Marco A.; Kalra, Ankur; Attizzani, Guilherme F.

In: Catheterization and Cardiovascular Interventions, 01.01.2018.

Research output: Contribution to journalArticle

Li, J, Patel, SM, Nadeem, F, Thakker, P, Al-Kindi, S, Thomas, R, Makani, A, Hornick, JM, Patel, T, Lipinski, J, Ichibori, Y, Davis, A, Markowitz, AH, Bezerra, HG, Simon, DI, Costa, MA, Kalra, A & Attizzani, GF 2018, 'Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement', Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.27894
Li, Jun ; Patel, Sandeep M. ; Nadeem, Fahd ; Thakker, Prashanth ; Al-Kindi, Sadeer ; Thomas, Rahul ; Makani, Amber ; Hornick, John M. ; Patel, Toral ; Lipinski, Jerry ; Ichibori, Yasuhiro ; Davis, Angela ; Markowitz, Alan H. ; Bezerra, Hiram G. ; Simon, Daniel I. ; Costa, Marco A. ; Kalra, Ankur ; Attizzani, Guilherme F. / Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement. In: Catheterization and Cardiovascular Interventions. 2018.
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abstract = "Objectives: This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). Background: There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. Methods: Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor). When feasible, SYNTAX scoring was performed for exploratory analysis. Analyses were performed using Cox proportional hazard models and Kaplan–Meier method. Results: A total of 323 patients with active CAD were included. Adjusted outcomes showed that patients with IR Major had increased incidence of acute myocardial infarction (AMI) or revascularization compared with those in the CR cohort (HR 3.72, P = 0.048). No difference was noted in all-cause mortality or all-cause readmission rates. Exploratory secondary analysis with residual SYNTAX scores showed a significant interaction between disease burden and AMI/revascularization, as well as all-cause readmission. All-cause mortality remained unaffected based on residual SYNTAX scores. Conclusions: This is a retrospective single-center study reporting on pre-TAVR revascularization outcomes in patients with active CAD. In this analysis, we found that patients undergoing TAVR benefited from achieving complete revascularization to abate future incidence of AMI/revascularization. Despite this finding, all-cause mortality remained unaffected. Future efforts should focus on the role of functional assessment of the coronaries, as well as the long-term effects of complete revascularization in a larger patient cohort.",
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AU - Li, Jun

AU - Patel, Sandeep M.

AU - Nadeem, Fahd

AU - Thakker, Prashanth

AU - Al-Kindi, Sadeer

AU - Thomas, Rahul

AU - Makani, Amber

AU - Hornick, John M.

AU - Patel, Toral

AU - Lipinski, Jerry

AU - Ichibori, Yasuhiro

AU - Davis, Angela

AU - Markowitz, Alan H.

AU - Bezerra, Hiram G.

AU - Simon, Daniel I.

AU - Costa, Marco A.

AU - Kalra, Ankur

AU - Attizzani, Guilherme F.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). Background: There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. Methods: Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor). When feasible, SYNTAX scoring was performed for exploratory analysis. Analyses were performed using Cox proportional hazard models and Kaplan–Meier method. Results: A total of 323 patients with active CAD were included. Adjusted outcomes showed that patients with IR Major had increased incidence of acute myocardial infarction (AMI) or revascularization compared with those in the CR cohort (HR 3.72, P = 0.048). No difference was noted in all-cause mortality or all-cause readmission rates. Exploratory secondary analysis with residual SYNTAX scores showed a significant interaction between disease burden and AMI/revascularization, as well as all-cause readmission. All-cause mortality remained unaffected based on residual SYNTAX scores. Conclusions: This is a retrospective single-center study reporting on pre-TAVR revascularization outcomes in patients with active CAD. In this analysis, we found that patients undergoing TAVR benefited from achieving complete revascularization to abate future incidence of AMI/revascularization. Despite this finding, all-cause mortality remained unaffected. Future efforts should focus on the role of functional assessment of the coronaries, as well as the long-term effects of complete revascularization in a larger patient cohort.

AB - Objectives: This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). Background: There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. Methods: Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor). When feasible, SYNTAX scoring was performed for exploratory analysis. Analyses were performed using Cox proportional hazard models and Kaplan–Meier method. Results: A total of 323 patients with active CAD were included. Adjusted outcomes showed that patients with IR Major had increased incidence of acute myocardial infarction (AMI) or revascularization compared with those in the CR cohort (HR 3.72, P = 0.048). No difference was noted in all-cause mortality or all-cause readmission rates. Exploratory secondary analysis with residual SYNTAX scores showed a significant interaction between disease burden and AMI/revascularization, as well as all-cause readmission. All-cause mortality remained unaffected based on residual SYNTAX scores. Conclusions: This is a retrospective single-center study reporting on pre-TAVR revascularization outcomes in patients with active CAD. In this analysis, we found that patients undergoing TAVR benefited from achieving complete revascularization to abate future incidence of AMI/revascularization. Despite this finding, all-cause mortality remained unaffected. Future efforts should focus on the role of functional assessment of the coronaries, as well as the long-term effects of complete revascularization in a larger patient cohort.

KW - AVD - aortic valve disease

KW - CAD - coronary artery disease

KW - PCI - percutaneous coronary intervention (PCI)

KW - percutaneous intervention

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