Single-Center Study Supports CTCA for Routine Pre-TAVR Imaging

August 10, 2015—Alaide Chieffo, MD, et al published findings on the benefit of routine screening of coronary artery disease (CAD) with computed tomographic coronary angiography (CTCA) instead of invasive coronary angiography (CA) in patients undergoing transcatheter aortic valve replacement (TAVR) in a single-center investigation. The study is available online in Circulation: Cardiovascular Interventions.

The investigators concluded that CTCA performed as a routine noninvasive imaging tool in patients undergoing TAVR seems safe and effective, allowing acquisition of information on aortic annulus anatomy, peripheral access sites, and evaluation of coronary anatomy with a single test.

The background of the study is that invasive CA remains the gold standard for CAD screening before TAVR, but CTCA could be a safe and effective noninvasive alternative for CAD screening in patients undergoing TAVR.

As summarized in Circulation: Cardiovascular Interventions, the study cohort included all patients undergoing TAVR at the investigators’ institution—San Raffaele Scientific Institute in Milan, Italy—from November 2007 to May 2013. CTCA was used as first-line imaging tool for CAD screening. Invasive CA was performed when the coronary anatomy was not evaluable or there was significant CAD present at CTCA.

The study's primary objective was to compare major adverse cardiovascular and cerebrovascular events at 30 days and 1 year between patients who underwent CTCA as the only screening test and those who underwent CTCA and invasive CA.

Of 491 patients treated with TAVR, 375 (76.3%) underwent only CTCA; 116 patients (21.7%) also underwent CA. No differences were present in crude major adverse cardiovascular and cerebrovascular event rates at 30 days and 1 year between the two groups. After multivariable adjustment, CTCA alone was not associated with higher risk of major adverse cardiovascular and cerebrovascular events at 1 year of follow-up, reported the investigators in Circulation: Cardiovascular Interventions.