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.

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