Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation.
Background: The impact of coronary artery disease (CAD) on outcomes after transcatheter aortic valve implantation (TAVI) has not been clarified. Furthermore, less is known about the indication and strategy of revascularization in these high risk patients. Aims: This study sought to determine the pre...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2015-04-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fcvm.2015.00018/full |
| _version_ | 1811337088333774848 |
|---|---|
| author | Jennifer eMancio Ricardo eFontes-Carvalho Ricardo eFontes-Carvalho Marco eOliveira Daniel eCaeiro Pedro eBraga Nuno eBettencourt Nuno eBettencourt Vasco Gama Ribeiro |
| author_facet | Jennifer eMancio Ricardo eFontes-Carvalho Ricardo eFontes-Carvalho Marco eOliveira Daniel eCaeiro Pedro eBraga Nuno eBettencourt Nuno eBettencourt Vasco Gama Ribeiro |
| author_sort | Jennifer eMancio |
| collection | DOAJ |
| description | Background: The impact of coronary artery disease (CAD) on outcomes after transcatheter aortic valve implantation (TAVI) has not been clarified. Furthermore, less is known about the indication and strategy of revascularization in these high risk patients. Aims: This study sought to determine the prevalence and prognostic impact of CAD in patients undergoing TAVI, and to assess the safety and feasibility of percutaneous coronary intervention (PCI) before TAVI.Methods: Patients with severe aortic stenosis (AS) undergoing TAVI were included into a prospective single centre registry from 2007 to 2012. Clinical outcomes were compared between patients with and without CAD. In some patients with CAD it was decided to perform elective PCI before TAVI after decision by the Heart Team. The primary endpoints were 30-day and 2-year all-cause mortality.Results: A total of 91 consecutive patients with mean age of 79±9 years (52% men) underwent TAVI with a median follow-up duration of 16 months (interquartile range of 27.6 months). CAD was present on 46 patients (51%). At 30-day, the incidences of death were similar between CAD and non-CAD patients (9% and 5%, p=0.44), but at 2 years were 50% in CAD patients and 24% in non-CAD patients (crude hazard ratio with CAD, 2.2; 95% confidence interval [CI], 1.1 to 4.6; p=0.04). Adjusting for age, gender, left ventricular ejection fraction and glomerular filtration rate the hazard of death was 2.6-fold higher in patients with CAD (95% CI, 1.1 to 6.0; p=0.03). Elective PCI before TAVI was performed in 13 patients (28% of CAD patients). There were no more adverse events in patients who underwent TAVI+PCI when compared with those who underwent isolated TAVI. Conclusions: In severe symptomatic AS who underwent TAVI, CAD is frequent and adversely impacts long-term outcomes, but not procedure outcomes. In selected patients, PCI before TAVI appears to be feasible and safe. |
| first_indexed | 2024-04-13T17:49:53Z |
| format | Article |
| id | doaj.art-82d3094ab7af49a395f1ea84637fe9bf |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-13T17:49:53Z |
| publishDate | 2015-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-82d3094ab7af49a395f1ea84637fe9bf2022-12-22T02:36:47ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2015-04-01210.3389/fcvm.2015.00018121951Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation.Jennifer eMancio0Ricardo eFontes-Carvalho1Ricardo eFontes-Carvalho2Marco eOliveira3Daniel eCaeiro4Pedro eBraga5Nuno eBettencourt6Nuno eBettencourt7Vasco Gama Ribeiro8Hospital Center of GaiaHospital Center of GaiaMedical School of PortoHospital Center of GaiaHospital Center of GaiaHospital Center of GaiaHospital Center of GaiaMedical School of PortoHospital Center of GaiaBackground: The impact of coronary artery disease (CAD) on outcomes after transcatheter aortic valve implantation (TAVI) has not been clarified. Furthermore, less is known about the indication and strategy of revascularization in these high risk patients. Aims: This study sought to determine the prevalence and prognostic impact of CAD in patients undergoing TAVI, and to assess the safety and feasibility of percutaneous coronary intervention (PCI) before TAVI.Methods: Patients with severe aortic stenosis (AS) undergoing TAVI were included into a prospective single centre registry from 2007 to 2012. Clinical outcomes were compared between patients with and without CAD. In some patients with CAD it was decided to perform elective PCI before TAVI after decision by the Heart Team. The primary endpoints were 30-day and 2-year all-cause mortality.Results: A total of 91 consecutive patients with mean age of 79±9 years (52% men) underwent TAVI with a median follow-up duration of 16 months (interquartile range of 27.6 months). CAD was present on 46 patients (51%). At 30-day, the incidences of death were similar between CAD and non-CAD patients (9% and 5%, p=0.44), but at 2 years were 50% in CAD patients and 24% in non-CAD patients (crude hazard ratio with CAD, 2.2; 95% confidence interval [CI], 1.1 to 4.6; p=0.04). Adjusting for age, gender, left ventricular ejection fraction and glomerular filtration rate the hazard of death was 2.6-fold higher in patients with CAD (95% CI, 1.1 to 6.0; p=0.03). Elective PCI before TAVI was performed in 13 patients (28% of CAD patients). There were no more adverse events in patients who underwent TAVI+PCI when compared with those who underwent isolated TAVI. Conclusions: In severe symptomatic AS who underwent TAVI, CAD is frequent and adversely impacts long-term outcomes, but not procedure outcomes. In selected patients, PCI before TAVI appears to be feasible and safe.http://journal.frontiersin.org/Journal/10.3389/fcvm.2015.00018/fullAortic Valve StenosisCoronary DiseaseprognosisPercutaneous coronary angioplasty interventiontranscatheter aortic valve implantation |
| spellingShingle | Jennifer eMancio Ricardo eFontes-Carvalho Ricardo eFontes-Carvalho Marco eOliveira Daniel eCaeiro Pedro eBraga Nuno eBettencourt Nuno eBettencourt Vasco Gama Ribeiro Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation. Frontiers in Cardiovascular Medicine Aortic Valve Stenosis Coronary Disease prognosis Percutaneous coronary angioplasty intervention transcatheter aortic valve implantation |
| title | Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation. |
| title_full | Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation. |
| title_fullStr | Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation. |
| title_full_unstemmed | Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation. |
| title_short | Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation. |
| title_sort | coronary artery disease and symptomatic severe aortic valve stenosis clinical outcomes after transcatheter aortic valve implantation |
| topic | Aortic Valve Stenosis Coronary Disease prognosis Percutaneous coronary angioplasty intervention transcatheter aortic valve implantation |
| url | http://journal.frontiersin.org/Journal/10.3389/fcvm.2015.00018/full |
| work_keys_str_mv | AT jenniferemancio coronaryarterydiseaseandsymptomaticsevereaorticvalvestenosisclinicaloutcomesaftertranscatheteraorticvalveimplantation AT ricardoefontescarvalho coronaryarterydiseaseandsymptomaticsevereaorticvalvestenosisclinicaloutcomesaftertranscatheteraorticvalveimplantation AT ricardoefontescarvalho coronaryarterydiseaseandsymptomaticsevereaorticvalvestenosisclinicaloutcomesaftertranscatheteraorticvalveimplantation AT marcoeoliveira coronaryarterydiseaseandsymptomaticsevereaorticvalvestenosisclinicaloutcomesaftertranscatheteraorticvalveimplantation AT danielecaeiro coronaryarterydiseaseandsymptomaticsevereaorticvalvestenosisclinicaloutcomesaftertranscatheteraorticvalveimplantation AT pedroebraga coronaryarterydiseaseandsymptomaticsevereaorticvalvestenosisclinicaloutcomesaftertranscatheteraorticvalveimplantation AT nunoebettencourt coronaryarterydiseaseandsymptomaticsevereaorticvalvestenosisclinicaloutcomesaftertranscatheteraorticvalveimplantation AT nunoebettencourt coronaryarterydiseaseandsymptomaticsevereaorticvalvestenosisclinicaloutcomesaftertranscatheteraorticvalveimplantation AT vascogamaribeiro coronaryarterydiseaseandsymptomaticsevereaorticvalvestenosisclinicaloutcomesaftertranscatheteraorticvalveimplantation |