Antros Louca MD, Monér Alchay MD, Truls Råmunddal MD, PhD, Araz Rawshani MD, PhD, Henrik Hagström MD, PhD, Magnus Settergren MD, PhD, Konrad Nilsson MD, PhD, Bahira Shahim MD, PhD, Stefan James MD, PhD, Sasha Koul MD, PhD, Anna Myredal MD, PhD, Björn Redfors MD, PhD, Dan Ioanes MD, PhD, Sebastian Völz MD, PhD, Petur Petursson MD, PhD, Oskar Angerås MD, PhD
{"title":"经导管主动脉瓣置换术后的冠状动脉造影：来自 SWEDEHEART 登记的启示。","authors":"Antros Louca MD, Monér Alchay MD, Truls Råmunddal MD, PhD, Araz Rawshani MD, PhD, Henrik Hagström MD, PhD, Magnus Settergren MD, PhD, Konrad Nilsson MD, PhD, Bahira Shahim MD, PhD, Stefan James MD, PhD, Sasha Koul MD, PhD, Anna Myredal MD, PhD, Björn Redfors MD, PhD, Dan Ioanes MD, PhD, Sebastian Völz MD, PhD, Petur Petursson MD, PhD, Oskar Angerås MD, PhD","doi":"10.1002/ccd.31171","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Transcatheter aortic valve replacement (TAVR) is the most common treatment in patients with symptomatic severe aortic stenosis (AS). As concomitant coronary artery disease is common in AS patients, access to the coronary arteries following TAVR is of increasing importance.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>This study evaluated the incidence and risk factors for unplanned coronary angiography following TAVR and, using fluoroscopic time as a surrogate, analyzed the complexity of coronary artery cannulation.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>All patients who underwent TAVR in Sweden between 2008 and 2022 were identified using the SWEDEHEART registry. The cumulative incidence of coronary angiography after TAVR was analyzed with mortality as a competing risk. Angiography and PCI complexity were analyzed using fluoroscopic time and compared across different transcatheter heart valve designs.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Out of 9806 patients, 566 subsequently required coronary angiography. The incidence was highest for three-vessel and/or left main disease. Younger age, the extent of prior coronary artery disease, and peripheral vascular disease were associated with an increased risk of coronary angiography. Fluoroscopy time was increased in TAVR patients compared to the control group with the longest fluoroscopy times observed in cases involving supra-annular and self-expanding valves.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The incidence of coronary angiography following TAVR is still low. Younger patients and patients with concomitant coronary artery disease have a higher risk. Procedural time is longer in patients with a previous THV replacement. As TAVR is emerging as the first-line treatment in patients with longer life expectancy, facilitating coronary access is an important factor when considering which THV device to implant</p>\n </section>\n </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31171","citationCount":"0","resultStr":"{\"title\":\"Coronary angiography following transcatheter aortic valve replacement: Insights from the SWEDEHEART registry\",\"authors\":\"Antros Louca MD, Monér Alchay MD, Truls Råmunddal MD, PhD, Araz Rawshani MD, PhD, Henrik Hagström MD, PhD, Magnus Settergren MD, PhD, Konrad Nilsson MD, PhD, Bahira Shahim MD, PhD, Stefan James MD, PhD, Sasha Koul MD, PhD, Anna Myredal MD, PhD, Björn Redfors MD, PhD, Dan Ioanes MD, PhD, Sebastian Völz MD, PhD, Petur Petursson MD, PhD, Oskar Angerås MD, PhD\",\"doi\":\"10.1002/ccd.31171\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Transcatheter aortic valve replacement (TAVR) is the most common treatment in patients with symptomatic severe aortic stenosis (AS). As concomitant coronary artery disease is common in AS patients, access to the coronary arteries following TAVR is of increasing importance.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>This study evaluated the incidence and risk factors for unplanned coronary angiography following TAVR and, using fluoroscopic time as a surrogate, analyzed the complexity of coronary artery cannulation.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>All patients who underwent TAVR in Sweden between 2008 and 2022 were identified using the SWEDEHEART registry. The cumulative incidence of coronary angiography after TAVR was analyzed with mortality as a competing risk. Angiography and PCI complexity were analyzed using fluoroscopic time and compared across different transcatheter heart valve designs.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Out of 9806 patients, 566 subsequently required coronary angiography. 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Coronary angiography following transcatheter aortic valve replacement: Insights from the SWEDEHEART registry
Background
Transcatheter aortic valve replacement (TAVR) is the most common treatment in patients with symptomatic severe aortic stenosis (AS). As concomitant coronary artery disease is common in AS patients, access to the coronary arteries following TAVR is of increasing importance.
Objectives
This study evaluated the incidence and risk factors for unplanned coronary angiography following TAVR and, using fluoroscopic time as a surrogate, analyzed the complexity of coronary artery cannulation.
Methods
All patients who underwent TAVR in Sweden between 2008 and 2022 were identified using the SWEDEHEART registry. The cumulative incidence of coronary angiography after TAVR was analyzed with mortality as a competing risk. Angiography and PCI complexity were analyzed using fluoroscopic time and compared across different transcatheter heart valve designs.
Results
Out of 9806 patients, 566 subsequently required coronary angiography. The incidence was highest for three-vessel and/or left main disease. Younger age, the extent of prior coronary artery disease, and peripheral vascular disease were associated with an increased risk of coronary angiography. Fluoroscopy time was increased in TAVR patients compared to the control group with the longest fluoroscopy times observed in cases involving supra-annular and self-expanding valves.
Conclusions
The incidence of coronary angiography following TAVR is still low. Younger patients and patients with concomitant coronary artery disease have a higher risk. Procedural time is longer in patients with a previous THV replacement. As TAVR is emerging as the first-line treatment in patients with longer life expectancy, facilitating coronary access is an important factor when considering which THV device to implant
期刊介绍：
Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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