Introduction Prevalence of coronary artery disease (CAD) ranges from 30% to 60% of all patients with aortic valve stenosis (AVS). At present, little is known about the best management of CAD in patients undergoing trans-catheter aortic valve implantation (TAVI). Aim of this study is to investigate the prevalence, management and the immediate clinical impact of CAD in this population, with a special focus on the feasibility and safety of a physiologically-guided revascularization strategy. Methods and results A total of 287 consecutive patients undergoing TAVI in our center were retrospectively included in the analysis. Those presenting CAD (123, 43%) were divided in three groups, according to the therapeutic strategy adopted by the operator: optimal medical therapy group (42 out of 123, 34%), preventive-PCI for angiographically significant coronary lesions (34 out of 123, 28%) and a physiologically-guided strategy (47 out of 123, 38%). The mean Logistic EuroSCORE was 31 ± 24% in the CAD population, with a higher risk profile in medical therapy group. TAVI procedural success in the overall population was 96%. Thirty-day clinical outcome showed a higher incidence of MACEs in the optimal medical therapy and the preventive PCI group (11.9% and 5.9% respectively), with no occurrence of adverse events in the FFR-guided group. Conclusions The best management of CAD in TAVI is still under investigation. Despite a relatively limited sample size, our findings demonstrate the feasibility and safety of a physiologically-guided revascularization strategy. Larger trials are needed to confirm our observations and to assess the long-term clinical impact.

Coronary artery disease in patients undergoing transcatheter aortic valve implantation. A single center registry on prevalence, management and immediate clinical impact

Milano A.;
2017

Abstract

Introduction Prevalence of coronary artery disease (CAD) ranges from 30% to 60% of all patients with aortic valve stenosis (AVS). At present, little is known about the best management of CAD in patients undergoing trans-catheter aortic valve implantation (TAVI). Aim of this study is to investigate the prevalence, management and the immediate clinical impact of CAD in this population, with a special focus on the feasibility and safety of a physiologically-guided revascularization strategy. Methods and results A total of 287 consecutive patients undergoing TAVI in our center were retrospectively included in the analysis. Those presenting CAD (123, 43%) were divided in three groups, according to the therapeutic strategy adopted by the operator: optimal medical therapy group (42 out of 123, 34%), preventive-PCI for angiographically significant coronary lesions (34 out of 123, 28%) and a physiologically-guided strategy (47 out of 123, 38%). The mean Logistic EuroSCORE was 31 ± 24% in the CAD population, with a higher risk profile in medical therapy group. TAVI procedural success in the overall population was 96%. Thirty-day clinical outcome showed a higher incidence of MACEs in the optimal medical therapy and the preventive PCI group (11.9% and 5.9% respectively), with no occurrence of adverse events in the FFR-guided group. Conclusions The best management of CAD in TAVI is still under investigation. Despite a relatively limited sample size, our findings demonstrate the feasibility and safety of a physiologically-guided revascularization strategy. Larger trials are needed to confirm our observations and to assess the long-term clinical impact.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11586/230893
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