Etienne Puymirat1, Romain Didier2, Hélène Eltchaninoff3, Bernard Lung4, Jean-Philippe Collet5, Dominique Himbert4, Eric Durand3, Alain Leguerrier6, Pascal Leprince7, Jean Fajadet8, Emmanuel Teiger9, Karine Chevreul10, Michel Lièvre11, Didier Tchetché8, Florence Leclercq12, Stéphan Chassaing13, Hervé Le Breton14, Patrick Donzeau-Gouge15, Thierry Lefèvre15, Didier Carrié16, Martine Gillard2, Didier Blanchard1. 1. Department of Cardiology, European Hospital of Georges Pompidou, Public Assistance Hospitals of Paris, Paris Descartes University, Paris, France. 2. Department of Cardiology, Brest University Hospital, Brest, France. 3. Department of Cardiology, Rouen University Hospital, Rouen, France. 4. Department of Cardiology, Bichat University Hospital, Paris, France. 5. Department of Cardiology, Pitié Salpetrière University Hospital, Paris, France. 6. Department of Cardiology and Surgery, Rennes University Hospital, Rennes, France. 7. Department of Surgery, Pitié Salpetrière University Hospital, Paris, France. 8. Department of Cardiology, Clinique Pasteur, Toulouse, France. 9. Department of URC-ECO and Cardiology, Creteil University Hospital, Paris, France. 10. Public Assistance Hospitals of Paris, Hotel Dieu Hospital, Clinical Research Unit, Paris, France. 11. UMR and Department of Cardiology, Lyon University Hospital, Lyon, France. 12. Department of Cardiology, Montpellier University Hospital, Montpellier, France. 13. Department of Cardiology, Clinique Saint-Gatien, Tours, France. 14. Department of Cardiology, Rennes University Hospital, Rennes, France. 15. Department of Cardiology and Surgery, I Cardiovascular Institute Paris Sud, Private Hospital Jacques Cartier, Massy, France. 16. Department of Cardiology, CHU Toulouse Rangueil, University Paul Sabatier, Toulouse, France.
Abstract
BACKGROUND: Coronary artery disease (CAD) is common in patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of CAD distribution before TAVR on short- and long-term prognosis remains unclear. HYPOTHESIS: We hypothesized that the long-term clinical impact differs according to CAD distribution in patients undergoing TAVR using the FRench Aortic National CoreValve and Edwards (FRANCE-2) registry. METHODS: FRANCE-2 is a national French registry including all consecutive TAVR performed between 2010 and 2012 in 34 centers. Three-year mortality was assessed in relation to CAD status. CAD was defined as at least 1 coronary stenosis >50%. RESULTS: A total of 4201 patients were enrolled in the registry. For the present analysis, we excluded patients with a history of coronary artery bypass. CAD was reported in 1252 patients (30%). Half of the patients presented with coronary multivessel disease. CAD extent was associated with an increase in cardiovascular risk profile and in logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) (from 19.3% ± 12.8% to 21.9% ± 13.5%, P < 0.001). Mortality at 30 days and 3 years was 9% and 44%, respectively, in the overall population. In multivariate analyses, neither the presence nor the extent of CAD was associated with mortality at 3 years (presence of CAD, hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.78-1.07). A significant lesion of the left anterior descending (LAD) was associated with higher 3-year mortality (HR: 1.42; 95% CI: 1.10-1.87). CONCLUSIONS: CAD is not associated with decreased short- and long-term survival in patients undergoing TAVR. The potential deleterious effect of LAD disease on long-term survival and the need for revascularization before or at the time of TAVR should be validated in a randomized control trial.
BACKGROUND:Coronary artery disease (CAD) is common in patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of CAD distribution before TAVR on short- and long-term prognosis remains unclear. HYPOTHESIS: We hypothesized that the long-term clinical impact differs according to CAD distribution in patients undergoing TAVR using the FRench Aortic National CoreValve and Edwards (FRANCE-2) registry. METHODS: FRANCE-2 is a national French registry including all consecutive TAVR performed between 2010 and 2012 in 34 centers. Three-year mortality was assessed in relation to CAD status. CAD was defined as at least 1 coronary stenosis >50%. RESULTS: A total of 4201 patients were enrolled in the registry. For the present analysis, we excluded patients with a history of coronary artery bypass. CAD was reported in 1252 patients (30%). Half of the patients presented with coronary multivessel disease. CAD extent was associated with an increase in cardiovascular risk profile and in logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) (from 19.3% ± 12.8% to 21.9% ± 13.5%, P < 0.001). Mortality at 30 days and 3 years was 9% and 44%, respectively, in the overall population. In multivariate analyses, neither the presence nor the extent of CAD was associated with mortality at 3 years (presence of CAD, hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.78-1.07). A significant lesion of the left anterior descending (LAD) was associated with higher 3-year mortality (HR: 1.42; 95% CI: 1.10-1.87). CONCLUSIONS: CAD is not associated with decreased short- and long-term survival in patients undergoing TAVR. The potential deleterious effect of LAD disease on long-term survival and the need for revascularization before or at the time of TAVR should be validated in a randomized control trial.
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