Author + information
- Guy Witberg,
- Ehud Regev,
- Shmuel Chen,
- Abid Assali,
- Issi Barbash,
- David Planer,
- Hana Vaknin Assa,
- Victor Guetta,
- Vicky Zeniou,
- Katia Orvin,
- Haim Danenberg,
- Amit Segev and
- Ran Kornowski
Background: Coronary artery disease (CAD) is very common in patients referred for Transcatheter Aortic Vavle Replacement (TAVR), however, data regarding the prognostic significance of CAD in this population is conflicting. A few single center studies have suggested that only severe CAD is associated with worse prognosis.
Methods: We analyzed data on 1270 consecutive patients with severe Aortic Stenosis (AS) undergoing TAVR from 3 referral centers during 2008-2014. Patients were classified as having 1) no CAD 2) CAD with low SYNTAX Score (SS) – <22 3) CAD with medium/high SS – >22. We examined the association of CAD severity with all cause mortality following TAVR. In addition, we examined whether the completeness of pre-procedural revascularization, as determined by the residual SS (rSS) – >/< 8 is associated with post TAVR mortality using a Cox proportional hazards ratio model adjusted for multiple prognostic variables.
Results: Of the 1270 patients 847 (67%) had no CAD, 366 (28%) were in the low SS group and 57 (5%) were in the medium/high SS group. Overall, CAD severity was associated with a higher burden of comorbidities. The average SS and rSS were 7 vs. 29 and 5 vs.20 in the low and medium/high SS strata, respectively. Over a median follow up of 1.9 years 426 (33.5%) patients had died, 253 (29.9%) in the no CAD, 141 (38.6%) in the low SS and 32 (55.4%) in the medium/high SS groups, respectively (log rank p<0.001). the corresponding figures according to rSS strata were 104 (33.2%) and 59 (53.7%) for the more vs less complete revascularization groups (log rank p<0.001). After multivariate adjustment, both medium/high SS (HR=2.4, p<0.001) and high rSS (HR=1.9, p<0.001) were associated with increased mortality whereas patients in the low SS or rSS had similar mortality rates to patients without CAD (p=0.356 and p=0.244, respectively).
Conclusions: Our results show that severe CAD is associated with increased mortality post TAVR whereas lower severity CAD is not. In addition the data suggests that more complete revascularization pre TAVR may attenuate the association of severe CAD and mortality and thereby may be used to improve the outcomes of patients with severe CAD referred for TAVR.
Moderated Poster Contributions
Interventional Cardiology Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 1:00 p.m.-1:10 p.m.
Session Title: Refining TAVR Outcomes
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1224M-07
- 2017 American College of Cardiology Foundation