Coronary CT angiography instead of invasive angiography before TAVI: Feasibility and outcomes

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2024-11-01 DOI:10.1016/j.ijcard.2024.132694

Rebekka Vibjerg Jensen , Jesper Møller Jensen , Nadia Iraqi , Erik Lerkevang Grove , Ole Norling Mathiassen , Kamilla Bech Pedersen , Erik Parner , Jonathon Leipsic , Christian Juhl Terkelsen , Bjarne Linde Nørgaard

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引用次数: 0

Abstract

Aims

Concomitant coronary artery disease (CAD) is frequent in transcatheter aortic valve implantation (TAVI) candidates. Despite societal recommendations of performing invasive coronary angiography (ICA) for coronary assessment in the pre-TAVI diagnostic workup, the prognostic value of ICA and beneficial effect of revascularization in these patients remains unclear.

We aimed to determine feasibility and outcomes following a strategy of cardiac CT + coronary CT angiography (cCTA) rather than cardiac CT + ICA before TAVI.

Methods and results

We performed a single-center, observational cohort study including all patients, without previous coronary intervention, referred to TAVI between April 2020 and November 2021. CAD was assessed by cCTA, and only patients with proximal stenosis >70 %, or left main stenosis >50 %, or cCTA was non-evaluable regarding proximal segments were subsequently referred to ICA.

240 patients were included in the study. No adverse effects to pre-cCTA-scan nitroglycerin administration were observed. On cCTA, 92 % of the patients had atheroscerosis. 191 (80 %) patients had cCTA only performed, while 49 (20 %) patients underwent subsequent ICA. During a median (range) follow-up of 15 (6-25) months, no difference in procedural complication rates, mortality rates, or number of unplanned ICA was observed between patients evaluated with only cCTA vs cCTA+ICA.

Conclusions

Upfront cCTA instead of ICA for assessment of obstructive CAD in the diagnostic workup of patients with severe aortic stenosis referred to TAVI is feasible, safe, and with similar procedural and clinical outcomes. Randomized studies are warranted to further validate the safety of using CTA rather than ICA for coronary assessment in TAVI candidates.

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冠状动脉 CT 血管造影取代 TAVI 前的侵入性血管造影：可行性和结果

目的：经导管主动脉瓣植入术（TAVI）候选者中经常合并冠状动脉疾病（CAD）。尽管社会建议在经导管主动脉瓣植入术前的诊断工作中进行有创冠状动脉造影术（ICA）以评估冠状动脉情况，但 ICA 对这些患者的预后价值和血管重建的益处仍不清楚。我们的目的是确定 TAVI 术前心脏 CT + 冠状动脉 CT 血管造影（cCTA）而非心脏 CT + ICA 策略的可行性和结果：我们进行了一项单中心观察性队列研究，研究对象包括 2020 年 4 月至 2021 年 11 月期间转诊至 TAVI 的所有患者，他们既往未接受过冠状动脉介入治疗。CAD由cCTA评估，只有近端狭窄>70%或左主干狭窄>50%或cCTA对近端无评估价值的患者才会被转诊至ICA。240 名患者被纳入研究。在 cCTA 扫描前使用硝酸甘油未发现不良反应。在 cCTA 中，92% 的患者有动脉粥样硬化。191（80%）名患者只进行了 cCTA，49（20%）名患者随后进行了 ICA。中位（范围）随访时间为 15（Abdel-Wahab 等人，2012 年；Rapp 等人，2001 年；Sabbah 等人，2021 年；Gautier 等人，2011 年；Sankaramangalam 等人，2017 年；Otto 等人，2021 年；Tarantini 等人，2011 年）、2021；Tarantini 等人，2023；Vahanian 等人，2021；Faroux 等人，2019；Ferraro 等人，2020；Patterson 等人，2021；Blanke 等人，2019；Bleakley 和 Monaghan，2018；Knuuti et al、2020年；Moss等人，2017年；van den Boogert等人，2018年；Collet等人，2018年；Linde等人，2020年；Schmidt等人，2018年；Hansson等人，2013年[6-25]）个月，仅使用cCTA与使用cCTA+ICA评估的患者在程序并发症发生率、死亡率或非计划ICA次数方面未观察到差异：结论：在重度主动脉瓣狭窄患者转诊至 TAVI 的诊断过程中，用前期 cCTA 代替 ICA 评估阻塞性 CAD 是可行的、安全的，并且具有相似的手术和临床结果。有必要进行随机研究，以进一步验证在 TAVI 候选者的冠状动脉评估中使用 CTA 而非 ICA 的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.