Study Evaluates Optimized Screening of CAD With Invasive Coronary Angiography and Ad Hoc PCI During TAVR
August 11, 2017—In a study published online in Circulation: Cardiovascular Interventions, Marco Barbanti, MD, et al sought to describe an optimized approach to coronary artery disease (CAD) screening and management in patients undergoing transcatheter aortic valve replacement (TAVR).
The investigators concluded that in patients undergoing TAVR, screening of CAD with invasive coronary angiography and ad hoc percutaneous coronary intervention (PCI) during TAVR is feasible and was not associated with increased periprocedural risks. TAVR after PCI in the same session had similar outcomes to TAVR in which PCI was not performed.
As described by the investigators in Circulation: Cardiovascular Interventions, when invasive coronary angiography showed evidence of CAD, the treatment strategy and completeness of revascularization was determined based on coronary anatomy. TAVR was performed in the same setting if PCI was uncomplicated; otherwise, TAVR was postponed.
A total of 604 patients undergoing CAD screening at the time of a 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 two 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% of patients, respectively. The rate of acute kidney injury stage 2 or 3 was 3.3%.
At 2 years, the 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 a similar rate of the composite of death, disabling stroke, and myocardial infarction (10.4%) when compared with patients without CAD (14.8%), and patients with severe CAD left untreated (15.4%; P = .765), reported the study investigators.