Prognostic impact of coronary artery disease in patients undergoing transcatheter aortic valve replacement.

Background: The prognostic impact of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains unclear. We assessed the impact of CAD on TAVR procedural safety and long-term adverse outcomes by stratifying patients according to CAD burden.

Methods: This single-centre, retrospective study stratified patients into low-, intermediate- and high-burden according to angiographic severity and location. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular (CV) death, myocardial infarction (MI), hospitalization for heart failure (HHF) and major adverse coronary events (MACE).

Results: Of 1803 consecutive patients, low-, intermediate- and high-coronary burden was identified in 1281 (71 %), 382 (21 %) and 140 (8 %) patients, respectively. There were no differences in procedural outcomes or in-hospital mortality between groups. At a median follow-up of 4.8 (3.7-6.1) years, the incidence of all-cause mortality was 49 % vs 54 % vs 62 %, respectively. After adjusting for age and comorbidities, high-burden CAD was associated with all-cause mortality (HR: 1.35, 95 % CI 1.07-1.70, P = 0.011), CV-mortality (HR: 1.54, 95 % CI 1.07-2.17, P = 0.02) and MACE (adjusted HR 1.63, 95 % CI 1.23-2.15, P = 0.001), but not HHF (HR: 1.43, 95 % CI: 0.96-2.13, P = 0.082). Both intermediate- (HR 2.87, CI 1.83-4.50, P < 0.001) and high-burden groups (HR 2.69, 95 % CI 1.38-5.25, P = 0.004) were associated with MI.

Conclusions: Increasing CAD burden does not impact TAVR procedural safety and therefore revascularization should not be a pre-requisite before TAVR. High CAD burden is associated with long-term adverse events. This group would benefit from future studies addressing CAD management in TAVR patients.