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Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation

European heart journal, 2014-10, Vol.35 (37), p.2530-2540 [Peer Reviewed Journal]

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com. ;ISSN: 0195-668X ;EISSN: 1522-9645 ;DOI: 10.1093/eurheartj/ehu074 ;PMID: 24682843

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Title:
Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation
Author: Stefanini, Giulio G ; Stortecky, Stefan ; Cao, Davide ; Rat-Wirtzler, Julie ; O'Sullivan, Crochan J ; Gloekler, Steffen ; Buellesfeld, Lutz ; Khattab, Ahmed A ; Nietlispach, Fabian ; Pilgrim, Thomas ; Huber, Christoph ; Carrel, Thierry ; Meier, Bernhard ; Jüni, Peter ; Wenaweser, Peter ; Windecker, Stephan
Subjects: Aged, 80 and over ; Aortic Valve Stenosis - complications ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - pathology ; Aortic Valve Stenosis - surgery ; Coronary Artery Disease - complications ; Coronary Artery Disease - mortality ; Coronary Artery Disease - pathology ; Female ; Heart Valve Prosthesis ; Humans ; Male ; Myocardial Infarction - etiology ; Prospective Studies ; Severity of Illness Index ; Stroke - etiology ; Transcatheter Aortic Valve Replacement - instrumentation ; Transcatheter Aortic Valve Replacement - methods ; Transcatheter Aortic Valve Replacement - mortality ; Treatment Outcome
Is Part Of: European heart journal, 2014-10, Vol.35 (37), p.2530-2540
Description: The aim of this study was to evaluate whether coronary artery disease (CAD) severity exerts a gradient of risk in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). A total of 445 patients with severe AS undergoing TAVI were included into a prospective registry between 2007 and 2012. The preoperative SYNTAX score (SS) was determined from baseline coronary angiograms. In case of revascularization prior to TAVI, residual SS (rSS) was also determined. Clinical outcomes were compared between patients without CAD (n = 158), patients with low SS (0-22, n = 207), and patients with high SS (SS > 22, n = 80). The pre-specified primary endpoint was the composite of cardiovascular death, stroke, or myocardial infarction (MI). At 1 year, CAD severity was associated with higher rates of the primary endpoint (no CAD: 12.5%, low SS: 16.1%, high SS: 29.6%; P = 0.016). This was driven by differences in cardiovascular mortality (no CAD: 8.6%, low SS: 13.6%, high SS: 20.4%; P = 0.029), whereas the risk of stroke (no CAD: 5.1%, low SS: 3.3%, high SS: 6.7%; P = 0.79) and MI (no CAD: 1.5%, low SS: 1.1%, high SS: 4.0%; P = 0.54) was similar across the three groups. Patients with high SS received less complete revascularization as indicated by a higher rSS (21.2 ± 12.0 vs. 4.0 ± 4.4, P < 0.001) compared with patients with low SS. High rSS tertile (> 14) was associated with higher rates of the primary endpoint at 1 year (no CAD:12.5%, low rSS: 16.5%, high rSS: 26.3%, P = 0.043). Severity of CAD appears to be associated with impaired clinical outcomes at 1 year after TAVI. Patients with SS > 22 receive less complete revascularization and have a higher risk of cardiovascular death, stroke, or MI than patients without CAD or low SS.
Publisher: England
Language: English
Identifier: ISSN: 0195-668X
EISSN: 1522-9645
DOI: 10.1093/eurheartj/ehu074
PMID: 24682843
Source: GFMER Free Medical Journals
MEDLINE
Alma/SFX Local Collection

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Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com. ;ISSN: 0195-668X ;EISSN: 1522-9645 ;DOI: 10.1093/eurheartj/ehu074 ;PMID: 24682843

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