Currently, the American and European guidelines recommend coronary angioplasty in patients with severe aortic stenosis with lesions >70% (Class IIa) who will undergo transcatheter aortic valve replacement (TAVR). However, the benefit of performing a revascularization in these patients is still uncertain.
This prospective multicenter study included 2025 patients divided into two groups: complete revascularization (N = 1310) and incomplete revascularization (N = 715).
The primary endpoint (PEP) was all-cause mortality at 2 years. The study also included an additional PEP of all-cause mortality, stroke, acute myocardial infarction (AMI), or readmission for heart failure (HF) at 2 years. The secondary endpoint (SEP) was stroke, AMI, readmission for HF, and unplanned angioplasty at 2 years.
Mean patient age was 82 years old, and 59% of subjects were male. In most patients, clinical presentation was CF angina III/IV. Patients in the incomplete revascularization group more frequently had multivessel disease. The right coronary artery was treated in 63% of patients. Most coronary procedures were performed before TAVR, and transfemoral access was the primary choice. SAPIEN 3/3 Ultra (37%) and EVOLUT R/PRO/POR+ (37%) were the valves implanted.
Read also: EuroPCR 2022 | GLOBAL SYMPLICITY Registry.
There were no significant differences in the primary endpoints. Furthermore, an analysis of the different subpopulations yielded no differences either.
Conclusion
Complete revascularization in patients who are candidates for TAVR has no impact on the 2-year prognosis, regardless of subpopulation and level of myocardial risk. Therefore, not treating angiographically significant lesions in patients with stable coronary disease who will undergo TAVR would be reasonable.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Management of Myocardial Revascularization in Patients with Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation.
Reference: Giuliano Costa MD. REVASC-TAVI Investigators.
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