Optimized Screening of Coronary Artery Disease With Invasive Coronary Angiography and Ad Hoc Percutaneous Coronary Intervention During Transcatheter Aortic Valve Replacement-Reference-Cited by-同舟云学术

Optimized Screening of Coronary Artery Disease With Invasive Coronary Angiography and Ad Hoc Percutaneous Coronary Intervention During Transcatheter Aortic Valve Replacement

Published:2017-08 Issue:8 Volume:10 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Barbanti Marco¹,Todaro Denise¹,Costa Giuliano¹,Pilato Gerlando¹,Picci Andrea¹,Gulino Simona¹,Capranzano Piera¹,La Spina Ketty¹,Di Simone Emanuela¹,D’Arrigo Paolo¹,Deste Wanda¹,Indelicato Antonino¹,Cannata Stefano¹,Giannazzo Daniela¹,Immè Sebastiano¹,Tamburino Claudia¹,Patanè Martina¹,Buccheri Sergio¹,Capodanno Davide¹,Sgroi Carmelo¹,Tamburino Corrado¹

Affiliation:

1. From the Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., D.T., G.C., G.P., A.P., S.G., P.C., K.L.S., E.D.S., P.D., W.D., A.I., S.C., D.G., S.I., C.T., M.P., S.B., D.C., C.S., C.T.); and ETNA Foundation, Catania, Italy (C.T.).

Abstract

Background— We sought to describe an optimized approach to coronary artery disease (CAD) screening and management in patients undergoing transcatheter aortic valve replacement (TAVR). Methods and Results— When invasive coronary angiography showed CAD, the treatment strategy and completeness of revascularization was determined based on coronary anatomy. TAVR was performed in the same setting if percutaneous coronary intervention (PCI) was uncomplicated; otherwise TAVR was postponed. A total of 604 patients undergoing CAD screening at the time of TAVR procedure were prospectively included in this study. Severe CAD was found in 136 patients (22.5%). Among patients with severe CAD, 53 patients (8.8%) underwent uncomplicated PCI. After PCI, TAVR was postponed in 2 patients (0.3%). In 83 patients (13.8%), coronary angiography showed severe CAD that was left untreated. After TAVR, all-cause and cardiovascular 30-day mortality rates were 2.4% and 1.4%, respectively. Disabling stroke, myocardial infarction, and life-threatening bleeding occurred in 0.5%, 0.8%, and 4.0% of patients, respectively. Acute kidney injury II or III rate was 3.3%. At 2 years, all-cause mortality rate was 14.1%. Disabling stroke and myocardial infarction occurred in 2.5% and 1.8% of patients, respectively. Patients undergoing TAVR and PCI in the same session had similar rate of the composite of death, disabling stroke, and myocardial infarction when compared with patients without CAD, and patients with severe CAD left untreated (TAVR+PCI: 10.4%; severe CAD left untreated: 15.4%; no-CAD: 14.8%; P =0.765). Conclusions— In patients undergoing TAVR, screening of CAD with invasive coronary angiography and ad hoc PCI during TAVR is feasible and was not associated with increased periprocedural risks. PCI followed by TAVR in the same session had similar outcomes than TAVR in which PCI was not performed.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

Link

https://www.ahajournals.org/doi/pdf/10.1161/CIRCINTERVENTIONS.117.005234

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