Evaluation of coronary disease among patients undergoing transcatheter aortic valve implantation: propensity score matching analysis
Background Chronic coronary syndrome (CCS) is common among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Current guidelines recommend performance of percutaneous coronary intervention (PCI) of any > 70% proximal coronary lesions prior to TAVI. Aims To evaluate the outcomes of two diagnostic approaches for CCS clearance pre-TAVI and to determine the reduction in the need of invasive angiography (IA). Methods We investigated 2219 patients undergoing TAVI for severe aortic stenosis at two large centers with different pre-procedural strategies for CCS assessment: pre-TAVI computed tomography angiography (CTA) with selective invasive angiography according to CTA results or mandatory IA. We preformed propensity score matching analysis using a 1:1 ratio. The final study cohort included 870 matched patients. Peri-procedural complications were documented according to the VARC-2 criteria. Mortality rates were prospectively documented. Results Mean age of the study population was 82 ± 7, of whom 55% were female. Patients in the IA group had significantly higher rates of pre-TAVI PCI compared to the CTA group (39% vs. 22%, p < 0.001). Following TAVI, peri-procedural myocardial infarction (MI) rates were similar between the two groups (0.3% vs. 0.7%, p value = 0.41), but spontaneous MI were significantly lower among the IA group (0% vs. 1.3%, p value = 0.03). Kaplan–Meier’s survival analysis found that the cumulative probability of 1-year morality was similar between the two groups (p value log rank = 0.65). Cox regression analysis did not find association between CCS clearance strategy and outcome. Conclusions In elderly patients, CTA-driven approach for CCS evaluation pre-TAVI is a valid strategy with similar outcome as compared to invasive approach. CTA strategy significantly reduces invasive procedures rates without compromising patient’s outcome..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:113 |
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| Enthalten in: |
Zeitschrift für Kardiologie - 113(2023), 1 vom: 30. März, Seite 11-17 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Berkovitch, Anat [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Aortic valve |
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| Anmerkungen: |
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
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| doi: |
10.1007/s00392-023-02175-7 |
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| funding: |
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| 520 | |a Background Chronic coronary syndrome (CCS) is common among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Current guidelines recommend performance of percutaneous coronary intervention (PCI) of any > 70% proximal coronary lesions prior to TAVI. Aims To evaluate the outcomes of two diagnostic approaches for CCS clearance pre-TAVI and to determine the reduction in the need of invasive angiography (IA). Methods We investigated 2219 patients undergoing TAVI for severe aortic stenosis at two large centers with different pre-procedural strategies for CCS assessment: pre-TAVI computed tomography angiography (CTA) with selective invasive angiography according to CTA results or mandatory IA. We preformed propensity score matching analysis using a 1:1 ratio. The final study cohort included 870 matched patients. Peri-procedural complications were documented according to the VARC-2 criteria. Mortality rates were prospectively documented. Results Mean age of the study population was 82 ± 7, of whom 55% were female. Patients in the IA group had significantly higher rates of pre-TAVI PCI compared to the CTA group (39% vs. 22%, p < 0.001). Following TAVI, peri-procedural myocardial infarction (MI) rates were similar between the two groups (0.3% vs. 0.7%, p value = 0.41), but spontaneous MI were significantly lower among the IA group (0% vs. 1.3%, p value = 0.03). Kaplan–Meier’s survival analysis found that the cumulative probability of 1-year morality was similar between the two groups (p value log rank = 0.65). Cox regression analysis did not find association between CCS clearance strategy and outcome. Conclusions In elderly patients, CTA-driven approach for CCS evaluation pre-TAVI is a valid strategy with similar outcome as compared to invasive approach. CTA strategy significantly reduces invasive procedures rates without compromising patient’s outcome. | ||
| 650 | 4 | |a Aortic valve |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Transcatheter aortic valve replacement |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Coronary artery disease |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Finkelstein, Ariel |4 aut | |
| 700 | 1 | |a Barbash, Israel M. |4 aut | |
| 700 | 1 | |a Fefer, Paul |4 aut | |
| 700 | 1 | |a Maor, Elad |4 aut | |
| 700 | 1 | |a Banai, Shmuel |4 aut | |
| 700 | 1 | |a Brodov, Yafim |4 aut | |
| 700 | 1 | |a Goitein, Orly |4 aut | |
| 700 | 1 | |a Aviram, Galit |4 aut | |
| 700 | 1 | |a Halkin, Amir |4 aut | |
| 700 | 1 | |a Guetta, Victor |4 aut | |
| 700 | 1 | |a Steinvil, Arie |4 aut | |
| 700 | 1 | |a Segev, Amit |0 (orcid)0000-0002-2290-0400 |4 aut | |
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