After Transcatheter Aortic Valve Replacement (TAVR) acute coronary syndromes (ACS) are rare and mostly present as non-ST elevation events. In this context, the few ST elevation events have bad prognosis, with close to 30% mortality at 30 days. 

This study included patients undergoing TAVR between 2012 and 2017 admitted for acute coronary syndrome during followup. 

Of 142,845 patients analyzed, 6741 (only 4.7%) were admitted afterwards for and ACS within mean 297 days. Half these patients were admitted within 6 months. 

A history of coronary artery disease, prior revascularization, diabetes, valve in valve and kidney injury, at the time of TAVR, predicted future coronary events. 

ST elevation MIs (STEMI) were associated with higher mortality at 30 days and one year compared against non-STEMI events (31.4% vs. 15.5% and 51.2% vs. 41.3%, respectively; p<0.01).

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One third of non-STEMI patients were treated percutaneously. This strategy was associated to lower mortality at long term, but higher risk of repeat revascularization. 

Conclusion

After TAVR, ACS seldom occurs and mostly happens as non-ST elevation MI. The few STEMI events had high mortality at short term. 

Original Title: Incidence and Outcomes of Acute Coronary Syndrome After Transcatheter Aortic Valve Replacement.

Reference: Amgad Mentias et al. J Am Coll Cardiol Intv 2020, article in press. https://doi.org/10.1016/j.jcin.2019.11.027.

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