Paul Guedeney1,2, Didier Tchétché3, Anna Sonia Petronio4, Julinda Mehilli5, Samantha Sartori1, Thierry Lefèvre6, Patrizia Presbitero7, Piera Capranzano8, Alessandro Iadanza9, Gennaro Sardella10, Nicolas M Van Mieghem11, Sabato Sorrentino1, Bimmer E P M Claessen1, Jaya Chandrasekhar1, Birgit Vogel1, Deborah N Kalkman1, Emanuele Meliga12, Nicolas Dumonteil13, Chiara Fraccaro14, Daniela Trabattoni15, Ghada Mikhail16, Maria-Cruz Ferrer-Grazia17, Christoph Naber18, Peter Kievit19, Usman Baber1, Samin Sharma20, Marie-Claude Morice6, Alaide Chieffo21, Roxana Mehran1. 1. Icahn School of Medicine at Mount Sinai, New York, New York. 2. Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France. 3. Groupe CardioVasculaire Interventional, Clinique Pasteur, Toulouse, France. 4. AOUP Cisanello, University Hospital, Pisa, Italy. 5. Munich University Clinic, Ludwig-Maximilians-University and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany. 6. Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France. 7. Instituto Clinico Humanitas, Milan, Italy. 8. University of Catania, Catania, Italy. 9. Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy. 10. Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy. 11. Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands. 12. Department of Cardiology, Mauriziano Hospital, Turin, Italy. 13. Department of Cardiology, Rangueil University Hospital, Toulouse, France. 14. Department of Cardiology, University of Padova, Padova, Italy. 15. Department of Cardiology, Centro Cardiologico Monzino, Milan, Italy. 16. Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom. 17. Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain. 18. Department of Cardiology, Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen, Germany. 19. Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 20. Department of Cardiology, Mount Sinai Hospital, New York, New York. 21. San Raffaele Scientific Institute, Milan, Italy.
Abstract
OBJECTIVES: To evaluate the impact of coronary artery disease (CAD) with or without recent (≤ 30 days) percutaneous coronary intervention (PCI) in women undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: Although women display a specific risk-profile for both PCI and TAVR, the impact of CAD and PCI in the setting of TAVR in women is unclear. METHODS: The multinational Women's International Transcatheter Aortic Valve implantation registry enrolled consecutive female patients undergoing contemporary TAVR in 19 centers between 2013 and 2015. Patients with available coronary angiography or CT scan in the pre-operative assessment of TAVR were categorized as without CAD, with CAD but no recent PCI and CAD and recent PCI (≤30 days). All events were adjudicated according to the VARC-2 criteria. RESULTS: A total of 787 patients were included in this analysis, among whom 459 (58.3%) had no CAD, 247 (31.4%) had CAD without recent PCI and 81 (10.3%) underwent recent PCI (≤ 30 days before TAVR). After multivariable adjustment, both groups of CAD patients, without and with recent PCI, presented with higher risk of death, myocardial infarction or stroke, compared with patients without CAD (adj HR 1.56, 95%CI 1.03-2.39, P = 0.038 and adj HR 1.96, 95% CI 1.1-3.5, P = .021, respectively). Patients with recent PCI had increased risk of all-cause death (adj HR 1.89, 95% CI 1.0-3.5, P = 0.04) and stroke (adj HR 3.7, 95% CI 1.0-13.5, P = 0.046) compared with patients without CAD. CONCLUSION: The presence of CAD in women undergoing TAVR, with or without recent PCI, was associated with long-term poorer outcomes.
OBJECTIVES: To evaluate the impact of coronary artery disease (CAD) with or without recent (≤ 30 days) percutaneous coronary intervention (PCI) in women undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: Although women display a specific risk-profile for both PCI and TAVR, the impact of CAD and PCI in the setting of TAVR in women is unclear. METHODS: The multinational Women's International Transcatheter Aortic Valve implantation registry enrolled consecutive female patients undergoing contemporary TAVR in 19 centers between 2013 and 2015. Patients with available coronary angiography or CT scan in the pre-operative assessment of TAVR were categorized as without CAD, with CAD but no recent PCI and CAD and recent PCI (≤30 days). All events were adjudicated according to the VARC-2 criteria. RESULTS: A total of 787 patients were included in this analysis, among whom 459 (58.3%) had no CAD, 247 (31.4%) had CAD without recent PCI and 81 (10.3%) underwent recent PCI (≤ 30 days before TAVR). After multivariable adjustment, both groups of CAD patients, without and with recent PCI, presented with higher risk of death, myocardial infarction or stroke, compared with patients without CAD (adj HR 1.56, 95%CI 1.03-2.39, P = 0.038 and adj HR 1.96, 95% CI 1.1-3.5, P = .021, respectively). Patients with recent PCI had increased risk of all-cause death (adj HR 1.89, 95% CI 1.0-3.5, P = 0.04) and stroke (adj HR 3.7, 95% CI 1.0-13.5, P = 0.046) compared with patients without CAD. CONCLUSION: The presence of CAD in women undergoing TAVR, with or without recent PCI, was associated with long-term poorer outcomes.
Authors: Bartlomiej Perek; Anna Olasinska-Wisniewska; Marcin Misterski; Mateusz Puslecki; Marek Grygier; Piotr Buczkowski; Maciej Lesiak; Tomasz Stankowski; Lukasz Szarpak; Kurt Ruetzler; Oguz Turan; Marek Jemielity Journal: J Thorac Dis Date: 2021-02 Impact factor: 2.895