Cor Vasa 2017, 59(1):e23-e28 | DOI: 10.1016/j.crvasa.2017.01.012

Coronary artery disease in patients undergoing transcatheter aortic valve implantation. A single centre registry on prevalence, management and immediate clinical impact

Carlo Zivelonghi^a, Mattia Lunardi^a, Gabriele Pesarini^a, Roberto Scarsini^a, Anna Piccoli^a, Valeria Ferrero^a, Leonardo Gottin^b, Aldo Milano^b, Giuseppe Faggian^b, Corrado Vassanelli^a, Flavio Ribichini^a,*

^a Division of Cardiology, School of Medicine, University of Verona, Italy

^b Division of Cardiovascular Surgery, School of Medicine, University of Verona, Italy

Introduction: Prevalence of coronary artery disease (CAD) ranges from 30% to 60% of all patients with aortic valve stenosis (AVS). At present, little is known about the best management of CAD in patients undergoing trans-catheter aortic valve implantation (TAVI). Aim of this study is to investigate the prevalence, management and the immediate clinical impact of CAD in this population, with a special focus on the feasibility and safety of a physiologically-guided revascularization strategy.

Methods and results: A total of 287 consecutive patients undergoing TAVI in our centre were retrospectively included in the analysis. Those presenting CAD (123, 43%) were divided in three groups, according to the therapeutic strategy adopted by the operator: optimal medical therapy group (42 out of 123, 34%), preventive-PCI for angiographically significant coronary lesions (34 out of 123, 28%) and a physiologically-guided strategy (47 out of 123, 38%). The mean Logistic EuroSCORE was 31 ± 24 in the CAD population, with a higher risk profile in medical therapy group. TAVI procedural success in the overall population was 96%. Thirty-day clinical outcome showed a higher incidence of MACEs in the optimal medical therapy and the preventive PCI group (11.9% and 5.9%, respectively), with no occurrence of adverse events in the FFR-guided group.

Conclusions: The best management of CAD in TAVI is still under investigation. Despite a relatively limited sample size, our findings demonstrate the feasibility and safety of a physiologically-guided revascularization strategy. Larger trials are needed to confirm our observations and to assess the long-term clinical impact.

Keywords: Aortic valve stenosis; Coronary angiography; Myocardial revascularization; Trans-catheter aortic valve implantation

Received: November 19, 2016; Accepted: January 12, 2017; Published: February 1, 2017  Show citation