Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement

Abstract Objectives The aim of the study was to analyze the impact of concomitant coronary artery disease (CAD) assessed by the SYNTAX score (SS) and periprocedural percutaneous coronary intervention (PCI) on outcomes after transcatheter aortic valve replacement (TAVR). Background Due to controversi...

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Autores principales:	Tilman Stephan, Eva Thoma, Manuel Rattka, Dominik Felbel, Dominik Buckert, Wolfgang Rottbauer, Birgid Gonska, Sinisa Markovic
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Aortic valve disease Aortic stenosis Coronary artery disease Transcatheter aortic valve replacement Percutaneous valve therapy Percutaneous coronary intervention Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/26be92e019514add849aba19b5bb922d
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spelling	oai:doaj.org-article:26be92e019514add849aba19b5bb922d2021-12-05T12:05:20ZImpact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement10.1186/s12872-021-02374-y1471-2261https://doaj.org/article/26be92e019514add849aba19b5bb922d2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12872-021-02374-yhttps://doaj.org/toc/1471-2261Abstract Objectives The aim of the study was to analyze the impact of concomitant coronary artery disease (CAD) assessed by the SYNTAX score (SS) and periprocedural percutaneous coronary intervention (PCI) on outcomes after transcatheter aortic valve replacement (TAVR). Background Due to controversial data regarding the effect of CAD on outcomes after TAVR, proper revascularization strategies remain a matter of debate. Methods 553 patients with severe aortic stenosis undergoing TAVR were included in this study. SS was calculated for each patient at baseline and after PCI. Primary outcome was one-year all-cause mortality. Results 60.2% of patients (N = 333) exhibited CAD with a mean SS of 10.8 ± 8.8. Of those, 120 patients (36.0%) received periprocedural PCI. In the treatment group, mean SS was decreased from 14.9 ± 9.1 to 6.3 ± 6.7. Patients with concomitant CAD suffered more frequently from myocardial infarction (MI) post TAVR compared to those without CAD (2.1% vs. 0.0%; P < 0.01). In the CAD cohort, MI rates were comparable between patients with and without PCI (2.2% vs. 2.5%; P = 0.71). Regarding SS, patients with a residual SS < 8 showed significant lower rates of one-year mortality (9.0% vs. 18.2%; P = 0.016) and MACCE (16.5% vs. 32.2%; P = 0.001). Besides left bundle brunch, predictors for an increased one-year mortality were a residual SS ≥ 8 in the CAD group (OR = 3.17; P = 0.011) and a EuroSCORE ≥ 4% in the entire study population (OR = 2.18; P = 0.017). Conclusion Our results suggest that a residual SS-guided revascularization strategy may improve prognosis after TAVR in patients with concomitant CAD. PCI aiming for a residual SS < 8 was associated with improved one-year clinical outcomes.Tilman StephanEva ThomaManuel RattkaDominik FelbelDominik BuckertWolfgang RottbauerBirgid GonskaSinisa MarkovicBMCarticleAortic valve diseaseAortic stenosisCoronary artery diseaseTranscatheter aortic valve replacementPercutaneous valve therapyPercutaneous coronary interventionDiseases of the circulatory (Cardiovascular) systemRC666-701ENBMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Aortic valve disease Aortic stenosis Coronary artery disease Transcatheter aortic valve replacement Percutaneous valve therapy Percutaneous coronary intervention Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Aortic valve disease Aortic stenosis Coronary artery disease Transcatheter aortic valve replacement Percutaneous valve therapy Percutaneous coronary intervention Diseases of the circulatory (Cardiovascular) system RC666-701 Tilman Stephan Eva Thoma Manuel Rattka Dominik Felbel Dominik Buckert Wolfgang Rottbauer Birgid Gonska Sinisa Markovic Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement
description	Abstract Objectives The aim of the study was to analyze the impact of concomitant coronary artery disease (CAD) assessed by the SYNTAX score (SS) and periprocedural percutaneous coronary intervention (PCI) on outcomes after transcatheter aortic valve replacement (TAVR). Background Due to controversial data regarding the effect of CAD on outcomes after TAVR, proper revascularization strategies remain a matter of debate. Methods 553 patients with severe aortic stenosis undergoing TAVR were included in this study. SS was calculated for each patient at baseline and after PCI. Primary outcome was one-year all-cause mortality. Results 60.2% of patients (N = 333) exhibited CAD with a mean SS of 10.8 ± 8.8. Of those, 120 patients (36.0%) received periprocedural PCI. In the treatment group, mean SS was decreased from 14.9 ± 9.1 to 6.3 ± 6.7. Patients with concomitant CAD suffered more frequently from myocardial infarction (MI) post TAVR compared to those without CAD (2.1% vs. 0.0%; P < 0.01). In the CAD cohort, MI rates were comparable between patients with and without PCI (2.2% vs. 2.5%; P = 0.71). Regarding SS, patients with a residual SS < 8 showed significant lower rates of one-year mortality (9.0% vs. 18.2%; P = 0.016) and MACCE (16.5% vs. 32.2%; P = 0.001). Besides left bundle brunch, predictors for an increased one-year mortality were a residual SS ≥ 8 in the CAD group (OR = 3.17; P = 0.011) and a EuroSCORE ≥ 4% in the entire study population (OR = 2.18; P = 0.017). Conclusion Our results suggest that a residual SS-guided revascularization strategy may improve prognosis after TAVR in patients with concomitant CAD. PCI aiming for a residual SS < 8 was associated with improved one-year clinical outcomes.
format	article
author	Tilman Stephan Eva Thoma Manuel Rattka Dominik Felbel Dominik Buckert Wolfgang Rottbauer Birgid Gonska Sinisa Markovic
author_facet	Tilman Stephan Eva Thoma Manuel Rattka Dominik Felbel Dominik Buckert Wolfgang Rottbauer Birgid Gonska Sinisa Markovic
author_sort	Tilman Stephan
title	Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement
title_short	Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement
title_full	Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement
title_fullStr	Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement
title_full_unstemmed	Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement
title_sort	impact of extent of coronary artery disease and percutaneous revascularization assessed by the syntax score on outcomes following transcatheter aortic valve replacement
publisher	BMC
publishDate	2021
url	https://doaj.org/article/26be92e019514add849aba19b5bb922d
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Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement

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