Alaide Chieffo1, Gennaro Giustino2, Pietro Spagnolo2, Vasileios F Panoulas2, Matteo Montorfano2, Azeem Latib2, Filippo Figini2, Eustachio Agricola2, Chiara Gerli2, Annalisa Franco2, Manuela Giglio2, Micaela Cioni2, Ottavio Alfieri2, Paolo Guido Camici2, Antonio Colombo2. 1. From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.). chieffo.alaide@hsr.it. 2. From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
Abstract
BACKGROUND: Coronary artery disease (CAD) screening is required before transcatheter aortic valve implantation (TAVR). Although invasive coronary angiography (CA) remains the gold standard for CAD assessment, computed tomographic CA (CTCA) could be a safe and effective noninvasive alternative for CAD screening in patients undergoing TAVR. METHODS AND RESULTS: From November 2007 to May 2013, all patients undergoing TAVR at our institution were included in the study cohort. CTCA was used as first-line imaging tool for CAD screening. Invasive CA was performed when any of the following were present: coronary anatomy at CTCA was not evaluable and presence of significant CAD at CTCA. The primary objective was to compare major adverse cardiovascular and cerebrovascular events at 30 days and 1 year between patients who performed CTCA as only screening test and those who performed CTCA and invasive CA. Of 491 patients treated with TAVR, 375 (76.3%) performed only CTCA, whereas 116 (21.7%) underwent also CA. No differences were present in crude major adverse cardiovascular and cerebrovascular event rates at 30 days and 1 year between the 2 groups. After multivariable adjustment, CTCA performed alone was not associated with higher risk of MACE at 1 year of follow-up (hazard ratio, 0.89; 95% confidence interval, 0.49-1.60; P=0.69). CONCLUSIONS: CTCA performed as a routine noninvasive imaging tool in patients undergoing TAVR seems safe and effective allowing, with a single test, acquisition of information on aortic annulus anatomy, peripheral access sites, and evaluation of coronary anatomy.
BACKGROUND:Coronary artery disease (CAD) screening is required before transcatheter aortic valve implantation (TAVR). Although invasive coronary angiography (CA) remains the gold standard for CAD assessment, computed tomographic CA (CTCA) could be a safe and effective noninvasive alternative for CAD screening in patients undergoing TAVR. METHODS AND RESULTS: From November 2007 to May 2013, all patients undergoing TAVR at our institution were included in the study cohort. CTCA was used as first-line imaging tool for CAD screening. Invasive CA was performed when any of the following were present: coronary anatomy at CTCA was not evaluable and presence of significant CAD at CTCA. The primary objective was to compare major adverse cardiovascular and cerebrovascular events at 30 days and 1 year between patients who performed CTCA as only screening test and those who performed CTCA and invasive CA. Of 491 patients treated with TAVR, 375 (76.3%) performed only CTCA, whereas 116 (21.7%) underwent also CA. No differences were present in crude major adverse cardiovascular and cerebrovascular event rates at 30 days and 1 year between the 2 groups. After multivariable adjustment, CTCA performed alone was not associated with higher risk of MACE at 1 year of follow-up (hazard ratio, 0.89; 95% confidence interval, 0.49-1.60; P=0.69). CONCLUSIONS: CTCA performed as a routine noninvasive imaging tool in patients undergoing TAVR seems safe and effective allowing, with a single test, acquisition of information on aortic annulus anatomy, peripheral access sites, and evaluation of coronary anatomy.
Authors: Michael Michail; Abdul-Rahman Ihdayhid; Andrea Comella; Udit Thakur; James D Cameron; Liam M McCormick; Robert P Gooley; Stephen J Nicholls; Anthony Mathur; Alun D Hughes; Brian S Ko; Adam J Brown Journal: Circ Cardiovasc Interv Date: 2020-12-16 Impact factor: 6.546
Authors: Thomas P W van den Boogert; Bimmer E P M Claessen; Adrienne van Randen; Joost van Schuppen; S Matthijs Boekholdt; Marcel A M Beijk; M Karlijn Vrijmoeth; Jan Baan; M Marije Vis; Jacobus A Winkelman; Antoine H G Driessen; Jaap Stoker; R Nils Planken; Jose P Henriques Journal: J Clin Med Date: 2021-05-28 Impact factor: 4.241
Authors: Christopher Strong; António Ferreira; Rui Campante Teles; Gustavo Mendes; João Abecasis; Gonçalo Cardoso; Sara Guerreiro; Pedro Freitas; Ana Coutinho Santos; Carla Saraiva; João Brito; Luís Raposo; Pedro de Araújo Gonçalves; Henrique Mesquita Gabriel; Manuel de Sousa Almeida; Miguel Mendes Journal: Sci Rep Date: 2019-12-27 Impact factor: 4.379