AI Article Synopsis
- Coronary artery disease often coexists with aortic stenosis, and transcatheter aortic valve implantation (TAVI) has been recognized as a therapeutic option for younger, lower-risk patients who may need future coronary interventions.
- In a study analyzing 1,936 TAVI patients, only 3.5% required coronary access (CA) within 3 years post-TAVI, with successful CA achieved in all cases and a high clinical success rate (97.9%) for percutaneous coronary interventions.
- The findings indicated that the CA group had higher rates of coronary artery disease and related conditions; however, cardiovascular mortality was notably higher in the CA group compared to those without CA.
Article Abstract
Background: Coronary artery disease and aortic stenosis often coexist. Transcatheter aortic valve implantation (TAVI) has emerged as a valid therapeutic option for younger, lower-risk patients who may eventually require coronary artery disease treatment. Thus, post-TAVI coronary access (CA) and percutaneous coronary intervention are expected to increase. The purpose of this study was to retrospectively evaluate patients who were enrolled in the SOURCE 3 (SAPIEN 3 Aortic Bioprosthesis European Outcome) European registry for treatment with the balloon-expandable SAPIEN 3 transcatheter heart valve and underwent CA with or without percutaneous coronary intervention after TAVI.
Methods: Baseline characteristics and clinical outcomes of patients with or without CA up to 3 years after TAVI were compared. A Kaplan-Meier estimate with a univariate model determined the impact of CA on cardiac mortality.
Results: Of 1936 TAVI patients (mean age 81.6 years, 52% male), 68 (3.5%) had CA within 3 years (mean 441±332 days) after TAVI. At baseline, the logistic EuroSCORE was similar (20.2% versus 18.3%, =0.2, CA and non-CA groups, respectively). Higher rates of coronary artery disease (76.5% versus 50.6%, <0.001), myocardial infarction (20.6% versus 11.5%, =0.03) and previous coronary artery bypass graft (22.1% versus 11.0%, =0.01) were present in the CA group. In 100% of patients, CA was successfully achieved. The clinical success of percutaneous coronary intervention was 97.9%. Cardiovascular mortality was numerically higher in patients with CA than in those without CA.
Conclusions: In the large SOURCE 3 European registry, CA was needed at 3-year follow-up after TAVI with a balloon-expandable valve in 3.5% of patients and was successful in all patients. The clinical success of percutaneous coronary intervention was 97.9%. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02698956.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373469 | PMC |
| http://dx.doi.org/10.1161/CIRCINTERVENTIONS.120.008972 | DOI Listing |
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