While transcatheter aortic valve replacement (TAVR) has shown benefits, significant coronary artery disease affects 50% or more of patients who undergo such procedure. However, it is still unclear which is the best treatment strategy or how to handle this condition.
Quantitative flow ratio (QFR) could be a non-invasive option to assess the severity of coronary lesions and inform decision-making, although there are no specific studies about it in these scenarios.
This study included 318 patients who underwent TAVR and had a coronary angiography before implantation, without coronary revascularization by coronary angioplasty.
Coronary angiographies were analyzed using the SYNTAX Score to assess lesion severity. Additionally, QFR was performed, with a positive finding (≤ 0.80) in 78 patients (24.5%).
The primary endpoint was all-cause mortality at 3 years.
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The groups shared similar characteristics: the mean age was 84 years; 45% of subjects were men; 87.5% had hypertension, 25.5% had diabetes, 20% had COPD, 29.6% had atrial fibrillation, 19.2% had a history of coronary angioplasty, 8.5% had undergone myocardial revascularization surgery, 35.5% had impaired renal function, and an ejection fraction of 55%. There were no differences in functional class, although the incidence of previous myocardial infarction was higher in patients with positive QFR.
Patients with positive QFR had a higher SYNTAX Score (5 vs. 0, p <0.001).
Periprocedural mortality was higher among patients in the positive QFR group (8.9% vs. 0.4%, p >0.001), but there were no differences in major vascular complications, stroke, crossover to surgery, cardiogenic shock, or tamponade.
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The primary endpoint was higher in the positive QFR group (51.1% vs. 12.1%, p <0.001), although there were no significant differences when coronary lesions were analyzed by angiography (24.3% vs. 19.7%; P = 0.244). The multivariate analysis showed that QFR was a significant predictor of all-cause mortality (hazard ratio: 5.31 [95% confidence interval: 3.21–8.76]).
Conclusion
Coronary QFR can predict mortality in patients with severe aortic stenosis treated with TAVR without coronary revascularization.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Natural History of Coronary Atherosclerosis in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: The Role of Quantitative Flow Ratio.
Reference: Iginio Colaiori, et al. Circ Cardiovasc Interv. 2024;17:e013705. DOI: 10.1161/CIRCINTERVENTIONS.123.013705.
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