Coronary artery disease coexists in approximately half of patients undergoing transcatheter aortic valve implantation, making coronary assessment prior to the procedure essential. Invasive coronary angiography remains the reference standard; however, coronary computed tomography angiography has demonstrated high accuracy in ruling out significant coronary artery disease and may reduce the need for invasive testing.
In this context, the authors conducted a systematic review and meta-analysis to evaluate whether pre-TAVI coronary CT angiography can safely guide coronary assessment and decrease the use of invasive coronary angiography.
A total of 1,570 publications were identified, of which 5 studies met the inclusion criteria for the final analysis. All were cohort studies with one-year follow-up.
Overall, 3,073 patients were analyzed: 1,573 evaluated with coronary CT angiography and 1,500 with invasive coronary angiography. The mean age was 80.7 ± 7.3 years; 47.1% were women, and the prevalence of coronary artery disease was 48.95%. In most studies, only patients with proximal stenosis greater than 70%, left main stenosis greater than 50%, or non-diagnostic CT findings were referred for invasive coronary angiography.
Coronary CT Angiography Before TAVI: Reduces Invasive Coronary Angiography by More Than 50% Without Increasing One-Year Clinical Events
The use of coronary CT angiography allowed avoidance of invasive coronary angiography in 54.3% of patients and was associated with a significant reduction in planned percutaneous coronary intervention prior to TAVI (odds ratio 0.17; 95% confidence interval 0.03–0.91; p = 0.03). In absolute terms, 10.7% of patients in the CT group underwent pre-TAVI percutaneous coronary intervention, compared with 27.9% in the invasive angiography group.
No significant differences were observed in major clinical events. Cardiac mortality, myocardial infarction, all-cause mortality, major adverse cardiovascular events, and the need for revascularization after TAVI were similar between both strategies. Event rates were low and comparable, with all-cause mortality of 8.7% in the CT group and 8.9% in the invasive angiography group (p = 0.41), and major adverse cardiovascular events of 10.8% and 12.8%, respectively (p = 0.55).
Conclusion: CCTA as a Safe Initial Strategy for Coronary Assessment Before TAVI
Pre-TAVI coronary assessment using coronary CT angiography allows avoidance of invasive coronary angiography in more than half of patients and is associated with clinical outcomes comparable to a routine invasive strategy at one year. Coronary CT angiography may be considered a safe initial strategy to rule out significant coronary artery disease in selected patients. However, the available evidence is based on a limited number of observational studies and requires confirmation in larger randomized trials.
Original Title: Pre-TAVI CT Angiography for Coronary Artery Disease Assessment: A Systematic Review and Meta-Analysis of Clinical Outcomes.
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