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Prognostic impact of Coronary Artery Disease Severity and Revascularization in TAVI patients
Session:
Sessão de Comunicações Orais - Cardiologia de Intervenção
Speaker:
Gualter Santos Silva
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gualter Santos Silva; Cláudio Guerreiro; Ana Raquel Barbosa; Pedro Gonçalves Teixeira; Cátia Serena; Pedro Ribeiro Queirós; Mariana Ribeiro Da Silva; Mariana S. Brandão; Diogo Santos Ferreira; Francisco Sampaio; Daniel Caeiro; Alberto Rodrigues; Pedro Braga
Abstract
<p><strong>Background:</strong> Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis. In patients who undergo surgical aortic valve replacement, the presence of CAD and the need for CABG adversely influences short- and long-term outcomes. However, the impact of concomitant CAD and its revascularization in patients undergoing transcatheter aortic valve implantation (TAVI) is still a matter of debate.</p> <p> </p> <p><strong>Objective:</strong> The aim of this study was to evaluate the prognostic impact of CAD severity in 1-year all-cause mortality of patients undergoing TAVI and whether prior complete or incomplete reasonable revascularization can improve prognosis after TAVI.</p> <p> </p> <p><strong>Methods and Results</strong>: Retrospective analysis of a total of 575 patients (51,3% female, mean age 79,7 ± 7,7 years) who underwent TAVI from August 2007 to November 2018. 50,3% of patients had significant CAD (at least one stenosis > 50%) which 54,2% of these had history of prior revascularization (64,8% complete or incomplete reasonable revascularization and 35,2% incomplete revascularization).</p> <p>Pre-TAVI CAD severity was defined by the SYNTAX Score (SS) and reasonable revascularization by the residual SYNTAX Score (rSS). Patients without history of revascularization were stratified into 3 groups: no CAD (SS=0); nonsevere CAD (SS between 1 and 22); and severe CAD (SS ≥23); Patients who had undergone revascularization prior to TAVI were separated into 2 categories based on their residual SS: complete or incomplete reasonable revascularization (rSS<8) and incomplete revascularization (rSS≥8). The primary end point was an all-cause mortality. At 1 year, patients with severe CAD had significantly higher rates of mortality (no CAD: 9,8%, nonsevere CAD: 12,6%, severe CAD: 38,9%; P=0.001) without significant differences between patients with no CAD and nonsevere CAD (p=1,00). Patients with high rSS had significantly higher rates of mortality comparing to no CAD or rSS<8 (no CAD: 9,8%, rSS<8: 8,6%; rSS≥8: 28,0%, p=0.001) .</p> <p> </p> <p><strong>Conclusions: </strong>In our study, the presence of severe CAD (SS>=23) prior to TAVI was associated with increased 1-year all-cause mortality. In patients with previous history of revascularization, a complete/reasonable revascularization (lower rSS) was associated with lower long-term mortality, which may attenuate the association of severe CAD and mortality and therefore improve the prognosis of these patients.</p>
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