Coronary artery disease and outcomes following transcatheter aortic valve implantation

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Open Heart Pub Date : 2024-03-01 DOI:10.1136/openhrt-2024-002620

Sameer Kurmani, Bhavik Modi, Aditya Mukherjee, David Adlam, Amerjeet Banning, Andrew Ladwiniec, Raj Rajendra, Julia Baron, Elved Roberts, Andre Ng, Iain Squire, Gerald McCann, Nilesh J Samani, Jan Kovac

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Abstract

Background Aortic stenosis is a life-limiting condition for which transcatheter aortic valve implantation (TAVI) is an established therapy. Coronary artery disease (CAD) is frequently found in this patient group and optimal management in these patients remains uncertain. Objectives We sought to examine the association of coexistent CAD on mortality and hospital readmission in patients undergoing TAVI. Methods In this observational cohort study, we examined patients who underwent TAVI and segregated them by the presence of obstructive epicardial CAD. The primary outcome was 3-year mortality with secondary outcomes being readmission for (1) all-causes, (2) a MACE (Major Adverse Cardiovascular Event) composite endpoint and (3) acute coronary syndrome. Subsidiary outcomes included patient angina and breathlessness scores. Results 898 patients underwent TAVI, of which 488 (54.3%) had unobstructed coronary arteries and 410 (45.7%) had obstructive CAD. Overall, n=298 (33.2%) patients experienced the primary mortality endpoint with no significant difference when stratified according to CAD (n=160 (32.9%) vs n=136 (33.2%), HR 0.98, CI 0.78 to 1.24). After multivariate analysis, the presence of CAD had no effect on the primary outcome (HR 0.98, CI 0.68 to 1.40). There was no significant difference in readmission for any cause (n=181, 37.1% (CAD) vs n=169, 41.2% (no CAD), p=0.23), including no significant difference on readmission for MACE (n=48, 9.8% (CAD) vs n=45, 11.0% (no CAD), p=0.11). CAD at the time of TAVI also did not alter breathlessness or angina scores before/after TAVI (p>0.05). Conclusion Coexistent CAD had no significant association with mortality, any-cause readmission or symptoms for patients undergoing TAVI in our cohort. Data are available upon reasonable request. Data Sharing Statement: The data is stored on an NHS database within the University Hospitals of Leicester and contains patient-identifiable information. Access may be granted upon reasonable request through [fermeen.admani@uhl-tr.nhs.uk][1]. [1]: http://fermeen.admani@uhl-tr.nhs.uk

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冠状动脉疾病与经导管主动脉瓣植入术后的疗效

背景主动脉瓣狭窄是一种危及生命的疾病，经导管主动脉瓣植入术（TAVI）是一种成熟的治疗方法。冠状动脉疾病（CAD）经常出现在这一患者群体中，而这些患者的最佳治疗方法仍不确定。目的我们试图研究并存的 CAD 与接受 TAVI 患者的死亡率和再入院率之间的关系。方法在这项观察性队列研究中，我们对接受 TAVI 的患者进行了检查，并根据是否存在阻塞性心外膜 CAD 对患者进行了分类。主要结果是 3 年死亡率，次要结果是因以下原因再入院：（1）所有原因；（2）MACE（主要不良心血管事件）复合终点；（3）急性冠脉综合征。辅助结果包括患者心绞痛和呼吸困难评分。结果 898 名患者接受了 TAVI，其中 488 人（54.3%）冠状动脉未阻塞，410 人（45.7%）有阻塞性 CAD。总体而言，298 名患者（33.2%）达到了主要死亡终点，根据 CAD 进行分层后无显著差异（n=160 (32.9%) vs n=136 (33.2%)，HR 0.98，CI 0.78 至 1.24）。经过多变量分析，是否存在 CAD 对主要结果没有影响（HR 0.98，CI 0.68 至 1.40）。任何原因的再入院率无明显差异（181 人，37.1%（CAD）vs 169 人，41.2%（无 CAD），P=0.23），包括 MACE 再入院率无明显差异（48 人，9.8%（CAD）vs 45 人，11.0%（无 CAD），P=0.11）。进行 TAVI 时的 CAD 也不会改变 TAVI 前后的呼吸困难或心绞痛评分（P>0.05）。结论在我们的队列中，并存的 CAD 与接受 TAVI 的患者的死亡率、因任何原因再入院或症状无明显关系。如有合理要求，可提供相关数据。数据共享声明：数据存储在莱斯特大学医院的 NHS 数据库中，其中包含可识别患者身份的信息。可通过[fermeen.admani@uhl-tr.nhs.uk][1]提出合理要求后进行访问。[1]: http://fermeen.admani@uhl-tr.nhs.uk

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.