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Residual Syntax SCORE in TAVR Patients
Session:
Posters (Sessão 3 - Écran 7) - Intervenção Coronária e Estrutural 1 - Vários
Speaker:
Pedro Custodio
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Pedro Custódio; Sérgio Madeira; Rui Teles; Manuel Almeida; Miguel Mendes
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> P</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">rior to <span style="font-size:10.5pt"><span style="background-color:white"><span style="color:#212121">transcatheter aortic valve replacement (TAVR)</span></span></span>, studies reported the inaccuracy to clinically predict the presence and severity of coronary artery disease (CAD) in severe aortic stenosis(SAS) based on symptoms.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> In the TAVR era, especially for patients with high surgical risk, bypassing the opportunity to do a simultaneous percutaneous intervention in the presence of CAD seems more acceptable than to lose the opportunity to perform a single surgery in patients awaiting surgical valve correction. Recent reports have advocated the feasibility of coronary angiography (CA) after TAVR.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> Despite this, patients proposed to TAVR routinely perform a CA prior to the procedure.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim:</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">To assess the impact of Residual SYNTAX score (RSs) in 2-year mortality of patients undergoing TAVR.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single center retrospective study from a prospectively collected institutional registry (VCROSS).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients that underwent TAVR between January 2009 and December 2018 – 517. Patients who underwent pre TAVR CA in the context of acute coronary syndrome or at other institution were excluded (n=138). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Obstructive CAD was defined as stenosis > 50% in a major epicardial vessels (> 2.5 mm) a<span style="background-color:white"><span style="color:black">nd SYNTAX score (Ss) was calculated according to recommended guidelines</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">RSs was calculated by subtracting the points of the treated lesions from the initial Ss</span></span>.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> We defined a cut-off point for RSS I < 7 as a reasonable revascularization. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Univariate analysis was performed to assess: - 1) differences between patients with or without CAD and between those with significant CAD who have or have not undergone PCI; - 2) variables associated with 2-year mortality. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Binary logistic regression was performed to identify independent predictors of 2-year mortality, accounting the differences and variables present in point 1) and 2). </span></span></p> <p> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results and Discussion:</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 379 patients were included, 54.8% male with an average age of 83,1YO (SD - 6.3), mean Ss was 8,02 and mean RSs was 6,22. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">55 patients (14.5%) presented with normal coronary arteries, 120(31.6%) with non-obstructive CAD and 204(53.8%) with obstructive CAD. Out of the latter, 110(29%) underwent PCI, based on the amenability to intervention. </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 gender, previous history of percutaneous coronary interventions (PCI) and coronary artery bypass grafting (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 were found in the PCI vs non-PCI group, apart from previous history of ICP and CABG. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> Diabetes mellitus, previous history of PCI and ejection fraction < 50% had a negative impact in the 2-year survival of the studied population. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> The RSs showed no statistically significant impact in this outcome, neither showed having a RSs < 7 – Table 1.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Neither the RSs nor having RSs<7 in patients referred to TAVR showed an impact the 2year mortality.</span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> </span></span></p> <p> </p> <p> </p> <p> </p>
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