Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation.

Stefanini, Giulio G.; Stortecky, Stefan; Cao, Davide; Rat-Wirtzler, Julie; O'Sullivan, Crochan J.; Glökler, Steffen; Buellesfeld, Lutz; Khattab, Ahmed A.; Nietlispach, Fabian; Pilgrim, Thomas; Huber, Christoph; Carrel, Thierry; Meier, Bernhard; Jüni, Peter; Wenaweser, Peter; Windecker, Stephan (2014). Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation. European Heart Journal, 35(37), pp. 2530-2540. Oxford University Press 10.1093/eurheartj/ehu074

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AIM The aim of this study was to evaluate whether coronary artery disease (CAD) severity exerts a gradient of risk in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS A total of 445 patients with severe AS undergoing TAVI were included into a prospective registry between 2007 and 2012. The preoperative SYNTAX score (SS) was determined from baseline coronary angiograms. In case of revascularization prior to TAVI, residual SS (rSS) was also determined. Clinical outcomes were compared between patients without CAD (n = 158), patients with low SS (0-22, n = 207), and patients with high SS (SS >22, n = 80). The pre-specified primary endpoint was the composite of cardiovascular death, stroke, or myocardial infarction (MI). At 1 year, CAD severity was associated with higher rates of the primary endpoint (no CAD: 12.5%, low SS: 16.1%, high SS: 29.6%; P = 0.016). This was driven by differences in cardiovascular mortality (no CAD: 8.6%, low SS: 13.6%, high SS: 20.4%; P = 0.029), whereas the risk of stroke (no CAD: 5.1%, low SS: 3.3%, high SS: 6.7%; P = 0.79) and MI (no CAD: 1.5%, low SS: 1.1%, high SS: 4.0%; P = 0.54) was similar across the three groups. Patients with high SS received less complete revascularization as indicated by a higher rSS (21.2 ± 12.0 vs. 4.0 ± 4.4, P < 0.001) compared with patients with low SS. High rSS tertile (>14) was associated with higher rates of the primary endpoint at 1 year (no CAD: 12.5%, low rSS: 16.5%, high rSS: 26.3%, P = 0.043). CONCLUSIONS Severity of CAD appears to be associated with impaired clinical outcomes at 1 year after TAVI. Patients with SS >22 receive less complete revascularization and have a higher risk of cardiovascular death, stroke, or MI than patients without CAD or low SS.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Stefanini, Giulio; Stortecky, Stefan; Rat, Julie; O'Sullivan, Crochan John; Glökler, Steffen; Büllesfeld, Lutz; Khattab, Ahmed Aziz; Nietlispach, Fabian; Pilgrim, Thomas; Huber, Christoph; Carrel, Thierry; Meier, Bernhard; Jüni, Peter; Wenaweser, Peter Martin and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

08 Oct 2014 17:36

Last Modified:

28 Apr 2018 02:30

Publisher DOI:

10.1093/eurheartj/ehu074

PubMed ID:

24682843

Additional Information:

Stefanini and Stortecky contributed equally to this work.

Uncontrolled Keywords:

Aortic stenosis, Coronary artery disease, SYNTAX score, Transcatheter aortic valve implantation

BORIS DOI:

10.7892/boris.50119

URI:

https://boris.unibe.ch/id/eprint/50119

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