JACC. Cardiovascular interventions
Impact of Extent of Coronary Artery Disease in Transcatheter Aortic Valve Replacement: A PRO-TAVI Substudy
By Broeze GM, Aarts HM, da Silva Voorham J and 19 others.
Abstract
Background
Coronary artery disease is present in one-half of patients undergoing transcatheter aortic valve replacement (TAVR). The recent randomized controlled PRO-TAVI (Percutaneous Coronary Intervention Before Transcatheter Aortic Valve Implantation) trial indicated that deferral of percutaneous coronary intervention (PCI) is safe in patients with concomitant coronary artery disease at 1-year follow-up. The SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score quantifies the extent of coronary artery disease, which may guide individualized revascularization strategies.
Objectives
The aim of this study was to evaluate the association between SYNTAX score (SS) and clinical outcomes in patients undergoing TAVR.
Methods
This study was a substudy of the PRO-TAVI trial, including 466 patients with significant coronary artery disease undergoing TAVR randomized to deferral of PCI or PCI before TAVR. SS was calculated from preprocedural coronary angiograms, and patients were stratified by SS quartiles. The primary outcome was a composite of all-cause mortality, myocardial infarction, stroke, and major bleeding at 1 year. An ischemic composite outcome of all-cause mortality, myocardial infarction, and stroke was also assessed.