SPC365

Prognostic impact of the presence and management of coronary artery disease in patients undergoing TAVI

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: Pedro Custodio

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Posters
FP Number: ---
Authors: Pedro Custódio; Sérgio Madeiro; Luís Oliveira; Mariana Gonçalves; Gonçalo Cunha; Afonso Oliveira; João Brito; Sílvio Leal; Nelson Vale; Rui c Teles; Pedro Gonçalves; Henrique m Gabriel; Luís Raposo; Manuel de Sousa Almeida; Miguel Mendes

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Approximately half of transcatheter aortic valve implantation (TAVI) candidates have coronary artery disease (CAD). Controversial results have been reported regarding the effect of the presence/severity of CAD and its management on clinical outcomes post-TAVI.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aim</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To describe the presence, extension, severity and management of CAD pre-TAVI and to evaluate its impact on 2-year mortality in a real world all comers population.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods and population</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single centre retrospective analysis from a prospectively collected institutional registry (VCROSS) including 517 patients that underwent TAVI for severe aortic stenosis between January 2009 and December 2018 . &nbsp;Patients who underwent pre TAVI CA in the context of ACS or at other institution were excluded n=138. Ultimately 380 entered the analysis. Obstructive CAD was defined as stenosis &gt; 50% in in major epicardial vessels (&gt; 2.5 mm). The total number of major epicardial with obstructive CAD was reported as was assessed the number of those left untreated. Univariate analysis was performed to assess 1) differences between patients with or without CAD and between those with significant CAD &nbsp;who have or have not undergone PCI, 2) variables associated with 2-year mortality. Binary logistic regression was performed to identify independent predictors of 2-year mortality including the presence of significant CAD and the type of management.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;Resullts</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;A total of 380 patients were included, 55,3% male with an average age of 83YO(+/-6.3), mean Euroscore II of 4,35. 76 had previous coronary artery bypass grafting(CABG) and 136 had previous PCI(43 had both).</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;55 patients (14.4%) presented with normal coronary arteries, 120(31.6%) with non-obstructive CAD and 205(54%) with obstructive CAD. Out of the latter, 112(29.5%) underwent PCI. </span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Statistically significant differences were found between obstructive CAD vs non-obstructive patients in terms of age, previous history of ICP and CABG.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the subgroup population with obstructive CAD, no statistically significant differences was found in the PCI vs non PCI group, apart from previous history of ICP and CABG &ndash; Figure 1.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Diabetes mellitus, previous history of percutaneous coronary intervention (PCI) and reduced ejection fraction(rEF- defined has &lt;50% echocardiographically) had a negative prognostic impact in the 2 year mortality of the 380patients.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;2-year mortality was 14,5%(55patients). The presence and management of CAD pre TAVI had no impact in 2-year mortality, when accounting for the differences in previous ICP history, CABG, age, and rEF.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;Conclusion</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The presence and type of management of obstructive CAD in this real world all comers registry did not impact the prognosis at 2 years. </span></span></p>