The coexistence of coronary artery disease and severe aortic stenosis is common among patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of the hemodynamic changes induced by different transcatheter heart valve platforms on the progression of coronary artery disease remains unclear. The aim of this study was to evaluate the anatomical and functional progression of coronary atherosclerosis after TAVR using quantitative coronary angiography (QCA) and Quantitative Flow Ratio (QFR), comparing self-expanding valves (SEV) and balloon-expandable valves (BEV).
The primary endpoint was coronary artery disease progression between baseline coronary angiography and a repeat angiogram performed for clinical indications during follow-up, assessed by QCA and QFR. The secondary endpoint was to compare disease progression according to the type of implanted prosthesis (SEV vs. BEV).
Among the 3,383 patients who underwent TAVR between 2013 and 2024, 92 (2.7%) had both baseline coronary angiography and repeat angiography during follow-up. The mean age was 74.3 ± 10.3 years, 56.5% were men, and the median follow-up was 756 days (IQR: 254–1302). Previous percutaneous coronary intervention was present in 43.5% of patients, while 27.5% had a history of myocardial infarction. A total of 89 patients were included in the QCA analysis and 90 in the QFR analysis, with no relevant baseline clinical differences between patients treated with self-expanding and balloon-expandable valves.
Coronary artery disease progression was highly prevalent. According to the QCA analysis, 96.6% (86/89) of patients showed progression in at least one coronary vessel, whereas functional progression assessed by QFR was observed in 85.6% (77/90). The QFR analysis demonstrated lower functional disease progression among patients treated with balloon-expandable valves compared with self-expanding valves (39.4% vs. 21.9% at 1 year and 47.4% vs. 39.3% at 2 years; log-rank p=0.038), with a hazard ratio of 0.60 for BEV versus SEV (95% CI: 0.38–0.97; p=0.036). In contrast, the QCA analysis showed only a non-significant trend in the same direction (HR: 0.74; 95% CI: 0.47–1.18; p=0.20).
Conclusion: QFR suggests lower functional coronary artery disease progression with balloon-expandable valves
In conclusion, anatomical and functional progression of coronary artery disease was a frequent finding among patients who required repeat coronary angiography after TAVR. QFR assessment suggested lower functional disease progression in patients treated with balloon-expandable valves. However, these findings should be interpreted with caution because of the retrospective study design and the limited number of patients included, and therefore require confirmation in prospective studies.
