Publication Date
1-1-2023
Journal
Journal of the Society for Cardiovascular Angiography & Interventions
DOI
10.1016/j.jscai.2023.101056
PMID
39132404
PMCID
PMC11307520
PubMedCentral® Posted Date
6-27-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Clinical Assessment, Reporting and Tracking Program; percutaneous coronary intervention; transcathter aortic valve replacement; Veterans Affairs
Abstract
BACKGROUND: Obstructive coronary artery disease (CAD) is common in patients with severe symptomatic aortic stenosis. The management and impact of obstructive CAD in patients undergoing transcatheter aortic valve replacement (TAVR) have not been fully evaluated. We aimed to determine the patient characteristics and clinical outcomes among veterans undergoing TAVR with and without obstructive CAD and to determine temporal trends and association of pre-TAVR percutaneous coronary intervention (PCI) with clinical outcomes.
METHODS: We identified all patients who underwent TAVR from 2012 to 2021 in the VA Health Care System. The sample population was divided into patients with and without obstructive CAD and further stratified by coronary intervention status 1 year prior to TAVR. The primary outcome was 1-year all-cause mortality, and the secondary outcome was major bleeding.
RESULTS: During the study period, 759 patients underwent TAVR, and 282 (37%) had obstructive CAD. Obstructive CAD was associated with higher 1-year mortality (15.6% vs 7.1%;
CONCLUSIONS: Among veterans undergoing TAVR, the presence of obstructive CAD is associated with higher mortality though pre-TAVR coronary intervention is not associated with improved outcomes. Further studies could identify a subset of patients who may benefit from coronary revascularization prior to TAVR.