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Fujimoto T, Zen K, Kataoka E, Kitada T, Takahara M, Tani R, Nakamura S, Yashige M, Yamano M, Yamano T, Nakamura T, Matoba S. Balloon aortic valvuloplasty bridge to transcatheter aortic valve replacement is associated with worse in-hospital mortality. Int J Cardiol 2024; 413:132348. [PMID: 38977224 DOI: 10.1016/j.ijcard.2024.132348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Balloon aortic valvuloplasty (BAV) has gained renewed interest as a bridge to transcatheter aortic valve replacement (TAVR) for patients with aortic stenosis (AS). However, it is unclear whether they patients should undergo TAVR directly or receive a staged bridge to BAV before TAVR is unclear. We used a national database to examine the association between BAV and TAVR in patients with TAVR and its effect on in-hospital mortality. METHODS Using the nationwide inpatient database of the Japanese registry of all cardiac and vascular diseases and the combination of the diagnosis procedure combination, we retrospectively analyzed 27,600 patients with AS who underwent TAVR between October 2013 and March 2021. Outcomes of the direct TAVR group (n = 27,387) were compared with those of the BAV bridge to TAVR group (n = 213), which received BAV at least 1 day before TAVR. RESULTS The median age was 85 (interquartile range: 82-88) years, with 33.3% (n = 9188) being male. Unplanned/emergent admissions increased with TAVR, whereas the use of BAV bridge to TAVR decreased. The in-hospital mortality rate was 1.3% and decreased over time. However, the BAV bridge to TAVR had a significantly higher in-hospital mortality than direct TAVR (5.6% vs. 1.3%; p < .0001). Factors associated with in-hospital mortality included age, body mass index, chronic renal disease, percutaneous coronary intervention, and BAV bridge to TAVR. CONCLUSIONS In unplanned/emergent and planned admission settings, the in-hospital mortality rate for BAV bridge to TAVR is worse than that for direct TAVR. Practical criteria for BAV bridge to TAVR should be proposed to improve outcomes.
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Affiliation(s)
- Tomotaka Fujimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Eisuke Kataoka
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuya Kitada
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Motoyoshi Takahara
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryotaro Tani
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shunsuke Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Yashige
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Laterra G, Strazzieri O, Reddavid C, Scalia L, Agnello F, Lavalle S, Barbanti M. Evaluation and management of coronary artery disease in transcatheter aortic valve implantation candidates with severe aortic stenosis and coronary artery disease: technology and techniques. Expert Rev Med Devices 2024:1-11. [PMID: 39245979 DOI: 10.1080/17434440.2024.2401492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/16/2024] [Accepted: 09/03/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION Patients with severe aortic stenosis referred for transcatheter aortic valve implantation (TAVI) often present with concomitant coronary artery disease (CAD). The management of CAD in these patients remains a topic of debate, encompassing the evaluation and timing of percutaneous coronary intervention (PCI). AREAS COVERED This review article aims to offer an overview of the role of coronary revascularization in TAVI patients, highlighting the advantages and disadvantages of different strategies: PCI before, concomitant with, and after TAVI. Considering that TAVI indications are expanding and patients with low surgical risk are now being referred for TAVI, the rate of PCI among patients undergoing TAVI is expected to increase. Historically, PCI was performed before TAVI. However, there is now a growing trend to defer PCI until after TAVI. EXPERT OPINION It is plausible that in the future, there will be an increase in PCI after TAVI due to several factors: first, multiple studies have shown the safety of TAVI even in patients with severe untreated CAD; second, improvements in TAVI device implantation techniques, such as commissural alignment and patient-specific device selection, have improved access to the coronary arteries post-TAVI.
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Affiliation(s)
- Giulia Laterra
- Department of Medicine and Surgery, Università degli Studi di Enna "Kore", Enna, Italy
- Division of Cardiology, Ospedale Umberto I, ASP 4 di Enna, Enna, Italy
| | - Orazio Strazzieri
- Division of Cardiology, Ospedale Umberto I, ASP 4 di Enna, Enna, Italy
| | - Claudia Reddavid
- Division of Cardiology, Ospedale Umberto I, ASP 4 di Enna, Enna, Italy
| | - Lorenzo Scalia
- Division of Cardiology, Ospedale Umberto I, ASP 4 di Enna, Enna, Italy
| | - Federica Agnello
- Department of Medicine and Surgery, Università degli Studi di Enna "Kore", Enna, Italy
- Division of Cardiology, Ospedale Umberto I, ASP 4 di Enna, Enna, Italy
| | - Salvatore Lavalle
- Department of Medicine and Surgery, Università degli Studi di Enna "Kore", Enna, Italy
- Division of Radiology, Ospedale Umberto I, ASP 4 di Enna, Enna, Italy
| | - Marco Barbanti
- Department of Medicine and Surgery, Università degli Studi di Enna "Kore", Enna, Italy
- Division of Cardiology, Ospedale Umberto I, ASP 4 di Enna, Enna, Italy
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Lønborg J, Jabbari R, Sabbah M, Veien KT, Niemelä M, Freeman P, Linder R, Ioanes D, Terkelsen CJ, Kajander OA, Koul S, Savontaus M, Karjalainen P, Erglis A, Minkkinen M, Sørensen R, Tilsted HH, Holmvang L, Bieliauskas G, Ellert J, Piuhola J, Eftekhari A, Angerås O, Rück A, Christiansen EH, Jørgensen T, Özbek BT, Glinge C, Søndergaard L, De Backer O, Engstrøm T. PCI in Patients Undergoing Transcatheter Aortic-Valve Implantation. N Engl J Med 2024. [PMID: 39216095 DOI: 10.1056/nejmoa2401513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND The benefit of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease and severe aortic stenosis who are undergoing transcatheter aortic-valve implantation (TAVI) remains unclear. METHODS In an international trial, we randomly assigned, in a 1:1 ratio, patients with severe symptomatic aortic stenosis and at least one coronary-artery stenosis with a fractional flow reserve of 0.80 or less or a diameter stenosis of at least 90% either to undergo PCI or to receive conservative treatment, with all patients also undergoing TAVI. The primary end point was a major adverse cardiac event, defined as a composite of death from any cause, myocardial infarction, or urgent revascularization. Safety, including bleeding events and procedural complications, was assessed. RESULTS A total of 455 patients underwent randomization: 227 to the PCI group and 228 to the conservative-treatment group. The median age of the patients was 82 years (interquartile range, 78 to 85), and the median Society of Thoracic Surgeons-Procedural Risk of Mortality score (on a scale from 0 to 100%, with higher scores indicating a greater risk of death within 30 days after the procedure) was 3% (interquartile range, 2 to 4). At a median follow-up of 2 years (interquartile range, 1 to 4), a major adverse cardiac event (primary end point) had occurred in 60 patients (26%) in the PCI group and in 81 (36%) in the conservative-treatment group (hazard ratio, 0.71; 95% confidence interval [CI], 0.51 to 0.99; P = 0.04). A bleeding event occurred in 64 patients (28%) in the PCI group and in 45 (20%) in the conservative-treatment group (hazard ratio, 1.51; 95% CI, 1.03 to 2.22). In the PCI group, 7 patients (3%) had PCI procedure-related complications. CONCLUSIONS Among patients with coronary artery disease who were undergoing TAVI, PCI was associated with a lower risk of a composite of death from any cause, myocardial infarction, or urgent revascularization at a median follow-up of 2 years than conservative treatment. (Funded by Boston Scientific and the Danish Heart Foundation; NOTION-3 ClinicalTrials.gov number, NCT03058627.).
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Affiliation(s)
- Jacob Lønborg
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Reza Jabbari
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Muhammad Sabbah
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Karsten T Veien
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Matti Niemelä
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Phillip Freeman
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Rickard Linder
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Dan Ioanes
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Christian J Terkelsen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Olli A Kajander
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Sasha Koul
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Mikko Savontaus
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Pasi Karjalainen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Andrejs Erglis
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Mikko Minkkinen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Rikke Sørensen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Hans-Henrik Tilsted
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Lene Holmvang
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Gintautas Bieliauskas
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Julia Ellert
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Jarkko Piuhola
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Ashkan Eftekhari
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Oskar Angerås
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Andreas Rück
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Evald H Christiansen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Troels Jørgensen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Burcu T Özbek
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Charlotte Glinge
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Lars Søndergaard
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Ole De Backer
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
| | - Thomas Engstrøm
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.L., R.J., M. Sabbah, M.M., R.S., H.-H.T., L.H., G.B., T.J., B.T.Ö., C.G., L.S., O.D.B., T.E.), the Department of Clinical Medicine, University of Copenhagen (J.L., R.S., L.H., L.S., O.D.B., T.E.), and the Danish Heart Foundation (C.J.T.), Copenhagen, the Department of Cardiology, Odense University Hospital, Odense (K.T.V., J.E.), the Department of Cardiology, Aalborg University Hospital, Aalborg (P.F., A. Eftekhari), and the Department of Cardiology, Aarhus University Hospital, Aarhus (C.J.T., E.H.C.) - all in Denmark; the Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu (M.N., J.P.), the Heart Hospital, Tampere University Hospital, Well-being Services County of Pirkanmaa, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), the Heart Center, Turku University Hospital, Turku (M. Savontaus), and the Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki (P.K., M.M.) - all in Finland; the Department of Medicine, and the Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm (R.L., A.R.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., O.A.), and the Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund (S.K.) - all in Sweden; and the University of Latvia, Riga (A. Erglis)
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Kumar A, Reed GW, Kalra A. Editorial: Transcatheter aortic valve implantation with concomitant coronary artery disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 65:16-17. [PMID: 38749897 DOI: 10.1016/j.carrev.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 07/19/2024]
Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, USA
| | - Ankur Kalra
- Franciscan Health, Lafayette, IN, USA; Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN, USA.
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Khan SU, Dani SS, Ganatra S, Ahmed T, Agalan A, Khadke S, Agarwal S, Zaid S, Arshad HB, Zahid S, Shah AR, Goel SS, Kleiman NS. Percutaneous coronary intervention before transcatheter aortic valve implantation: A propensity score matched analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 65:10-15. [PMID: 38553281 DOI: 10.1016/j.carrev.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/22/2024] [Accepted: 03/18/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The role of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) who subsequently undergo transcatheter aortic valve replacement (TAVR) remains uncertain. Therefore, we conducted this study to assess the association of PCI before TAVR with mortality and cardiovascular outcomes. METHODS We used the TriNetX database (Jan 2012 - Aug 2022) and grouped patients into PCI (3 months or less) before TAVR and no PCI. We performed propensity score matched (PSM) analyses for outcomes at 30 days and 1 year. RESULTS Of 17,120 patients undergoing TAVR, 2322 (14 %) had PCI, and 14,798 (86 %) did not have PCI before TAVR. In the PSM cohort (2026 patients in each group), PCI was not associated with lower all-cause mortality at 30 days (HR: 1.25, 95 % CI: 0.82-1.90) or 1 year (HR: 1.02, 95 % CI: 0.83-1.24). Frequency of repeat PCI after TAVR was low in both no PCI vs. PCI (2.4 % vs. 1.2 %) at 1 year; PCI was associated with a lower rate of repeat PCI (HR: 0.49, 95 % CI: 0.30-0.80). Sensitivity analysis revealed an E-value of 3.5 for repeat PCI (E-value for lower CI for HR: 1.81). PCI was not linked to reductions in MI, heart failure exacerbation, all-cause hospitalization, major bleeding, or permanent pacemaker/implantable cardioverter defibrillator. CONCLUSION This analysis showed that PCI prior to TAVR was not associated with improvement in all-cause mortality. However, PCI was associated with a reduced rate of repeat PCI at 1 year.
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Affiliation(s)
- Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States.
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, United States
| | - Sarju Ganatra
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, United States
| | - Talha Ahmed
- Department of Cardiovascular Medicine, The University of Texas at Houston-Memorial Hermann Heart & Vascular Institute, Houston, TX, United States
| | - Amro Agalan
- Sands-Constellation Heart Institute Rochester General Hospital Rochester, NY, United States
| | - Sumanth Khadke
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, United States
| | - Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Hassaan B Arshad
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Salman Zahid
- Sands-Constellation Heart Institute Rochester General Hospital Rochester, NY, United States
| | - Alpesh R Shah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
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McHugh S, Allaham H, Chahal D, Gupta A. Coronary Artery Revascularization in Patients Undergoing Transcatheter Aortic Valve Replacement. Cardiol Clin 2024; 42:333-338. [PMID: 38910018 DOI: 10.1016/j.ccl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Patients with concomitant severe aortic stenosis and significant coronary artery disease present a diagnostic and therapeutic challenge in clinical practice. There are no clear-cut guidelines as to the timing of revascularization in these patients who are referred for transcatheter aortic valve replacement (TAVR). This article aims to show that in patients without high-grade proximal coronary artery disease, revascularization after TAVR is safe, feasible, and practical. Additionally, the use of preoperative TAVR computed tomographic angiography might be used in both intermediate and high-risk patients rather than invasive coronary angiography to assess for significant proximal coronary artery disease to help guide the timing of revascularization.
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Affiliation(s)
| | | | - Diljon Chahal
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anuj Gupta
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Fallahtafti P, Soleimani H, Ebrahimi P, Ghaseminejad‐Raeini A, Karimi E, Shirinezhad A, Sabri M, Mehrani M, Taheri H, Siegel R, Shah N, Nanna M, Hakim D, Hosseini K. Comparative Analysis of PCI Strategies in Aortic Stenosis Patients Undergoing TAVI: A Systematic Review and Network Meta-Analysis. Clin Cardiol 2024; 47:e24324. [PMID: 39054901 PMCID: PMC11272956 DOI: 10.1002/clc.24324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been increasingly used in patients with severe aortic stenosis (AS). Since coronary artery disease (CAD) is common among these patients, it is crucial to choose the best method and timing of revascularization. This study aims to compare different timing strategies of percutaneous coronary intervention (PCI) in patients with severe AS undergoing TAVI to clarify whether PCI timing affects the patients' outcomes or not. METHODS A frequentist network meta-analysis was conducted comparing three different revascularization strategies in patients with CAD undergoing TAVI. The 30-day all-cause mortality, in-hospital mortality, all-cause mortality at 1 year, 30-day rates of myocardial infarction (MI), stroke, and major bleeding, and the need for pacemaker implantation at 6 months were analyzed in this study. RESULTS Our meta-analysis revealed that PCI during TAVI had higher 30-day mortality (RR = 2.46, 95% CI = 1.40-4.32) and in-hospital mortality (RR = 1.70, 95% CI = [1.08-2.69]) compared to no PCI. Post-TAVI PCI was associated with higher 1-year mortality compared to other strategies. While no significant differences in major bleeding or stroke were observed, PCI during TAVI versus no PCI (RR = 3.63, 95% CI = 1.27-10.43) showed a higher rate of 30-day MI. CONCLUSION Our findings suggest that among patients with severe AS and CAD undergoing TAVI, PCI concomitantly with TAVI seems to be associated with worse 30-day outcomes compared with no PCI. PCI after TAVI demonstrated an increased risk of 1-year mortality compared to alternative strategies. Choosing a timing strategy should be individualized based on patient characteristics and procedural considerations.
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Affiliation(s)
- Parisa Fallahtafti
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Hamidreza Soleimani
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Pouya Ebrahimi
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | | | - Elaheh Karimi
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | | | - Mahshad Sabri
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Mehdi Mehrani
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Homa Taheri
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Robert Siegel
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Neeraj Shah
- Independence Health estmoreland HospitalGreensburgPennsylvaniaUSA
| | - Michael Nanna
- Section of Cardiovascular MedicineYale University School of MedicineNew HavenCTUSA
| | - Diaa Hakim
- Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
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Custódio P, Madeira S, Teles R, Almeida M. Coronary artery disease and its management in TAVI. Hellenic J Cardiol 2024; 78:36-41. [PMID: 37689181 DOI: 10.1016/j.hjc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/31/2023] [Accepted: 09/05/2023] [Indexed: 09/11/2023] Open
Abstract
OBJECTIVE Aortic stenosis and coronary artery disease (CAD) are frequently associated. The preprocedural evaluation and indications for treatment in patients undergoing transcatheter aortic valve intervention (TAVI) remain controversial. This study sought to 1) determine the prevalence and angiographic characteristics of CAD in TAVI candidates, along with revascularization patterns, and 2) to evaluate the impact of the presence and complexity of CAD, as well as angiography-guided percutaneous coronary intervention, on prognosis after TAVI. METHODS Single-center retrospective study from a prospectively collected institutional registry that included all patients that underwent TAVI between 2009 and 2018 and pre TAVI coronary angiography (CA) in our institution in the context of pre-procedure work-up. A multivariate analysis was performed to determine the effect of CAD and PCI on 2-year mortality. RESULTS A total of 379 patients were included: 55 patients (14.5%) presented with normal coronary arteries, 120 (31.6%) with non-obstructive CAD, and 204 (53.8%) with obstructive CAD (the mean SxS was 8.2). Ultimately, 110 patients (29%) underwent PCI. Two-year survival after TAVI was decreased in patients with complex coronary lesions (SS > 22), while it was not affected by the overall presence of non-obstructive CAD, obstructive CAD, residual SxS, or pre-TAVI PCI of angiographically significant lesions (OR 0.631, 95%CI 0.192-1.406). CONCLUSION In our population, the overall presence and management of obstructive CAD did not appear to impact mortality at 2 years after TAVI. Survival was decreased in patients with baseline complex coronary anatomies.
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Affiliation(s)
- Pedro Custódio
- Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.
| | | | - Rui Teles
- Hospital de Santa Cruz, Carnaxide, Portugal
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Brendel JM, Walterspiel J, Hagen F, Kübler J, Paul JF, Nikolaou K, Gawaz M, Greulich S, Krumm P, Winkelmann M. Coronary artery disease evaluation during transcatheter aortic valve replacement work-up using photon-counting CT and artificial intelligence. Diagn Interv Imaging 2024; 105:273-280. [PMID: 38368176 DOI: 10.1016/j.diii.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the capabilities of photon-counting (PC) CT combined with artificial intelligence-derived coronary computed tomography angiography (PC-CCTA) stenosis quantification and fractional flow reserve prediction (FFRai) for the assessment of coronary artery disease (CAD) in transcatheter aortic valve replacement (TAVR) work-up. MATERIALS AND METHODS Consecutive patients with severe symptomatic aortic valve stenosis referred for pre-TAVR work-up between October 2021 and June 2023 were included in this retrospective tertiary single-center study. All patients underwent both PC-CCTA and ICA within three months for reference standard diagnosis. PC-CCTA stenosis quantification (at 50% level) and FFRai (at 0.8 level) were predicted using two deep learning models (CorEx, Spimed-AI). Diagnostic performance for global CAD evaluation (at least one significant stenosis ≥ 50% or FFRai ≤ 0.8) was assessed. RESULTS A total of 260 patients (138 men, 122 women) with a mean age of 78.7 ± 8.1 (standard deviation) years (age range: 51-93 years) were evaluated. Significant CAD on ICA was present in 126/260 patients (48.5%). Per-patient sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 96.0% (95% confidence interval [CI]: 91.0-98.7), 68.7% (95% CI: 60.1-76.4), 74.3 % (95% CI: 69.1-78.8), 94.8% (95% CI: 88.5-97.8), and 81.9% (95% CI: 76.7-86.4) for PC-CCTA, and 96.8% (95% CI: 92.1-99.1), 87.3% (95% CI: 80.5-92.4), 87.8% (95% CI: 82.2-91.8), 96.7% (95% CI: 91.7-98.7), and 91.9% (95% CI: 87.9-94.9) for FFRai. Area under the curve of FFRai was 0.92 (95% CI: 0.88-0.95) compared to 0.82 for PC-CCTA (95% CI: 0.77-0.87) (P < 0.001). FFRai-guidance could have prevented the need for ICA in 121 out of 260 patients (46.5%) vs. 97 out of 260 (37.3%) using PC-CCTA alone (P < 0.001). CONCLUSION Deep learning-based photon-counting FFRai evaluation improves the accuracy of PC-CCTA ≥ 50% stenosis detection, reduces the need for ICA, and may be incorporated into the clinical TAVR work-up for the assessment of CAD.
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Affiliation(s)
- Jan M Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Jonathan Walterspiel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Florian Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Jens Kübler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Jean-François Paul
- Institut Mutualiste Montsouris, Department of Radiology, Cardiac Imaging, 75014 Paris, France; Spimed-AI, 75014 Paris, France
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, 72076 Germany
| | - Simon Greulich
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, 72076 Germany
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany.
| | - Moritz Winkelmann
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
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Mascherbauer J, Rudolph T, Strauch JT, Seiffert M, Bleiziffer S, Bartko PE, Zielinski M, Vijayan A, Bramlage P, Hengstenberg C. Preprocedural assessment of coronary artery disease in patients undergoing transcatheter aortic valve implantation: Rationale and design of the EASE-IT CT registry. Eur J Clin Invest 2024:e14274. [PMID: 38925546 DOI: 10.1111/eci.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/06/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Invasive coronary angiography (ICA) is the standard for pre-procedural assessment of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI). However, it requires hospitalization and can be associated with complications. Computed tomography angiography (CTA) may be a viable alternative to rule out prognostically relevant CAD. METHODS The EASE-IT CT Registry is an investigator-initiated, prospective, observational, multicentre pilot registry involving patients aged ≥75 years with severe aortic stenosis (AS) intended to implant a transcatheter heart valve (THV) of the SAPIEN family. A total of 150 patients will be recruited from four sites in Germany and Austria. The registry will consist of two prospective cohorts: the investigational CTA-only cohort and the CTA + ICA control cohort. The CTA-only cohort will enrol 100 patients in whom significant (≥50%) left main (LM) and/or proximal left anterior descending artery (LAD) stenosis are ruled out on CTA. The CTA + ICA control cohort will enrol 50 patients who have undergone both CTA and ICA before TAVI and in whom ≥50% LM/proximal LAD stenosis has been ruled out by CTA. Three composite endpoints will be assessed at 3 months post-TAVI: CAD-specific endpoints, VARC-3-defined device success and early safety. CONCLUSION The EASE-IT CT Registry evaluates whether TAVI can be carried out safely without performing ICA if prognostically relevant CAD of the LM/proximal LAD is ruled out with CTA. If so, the omission of ICA would help streamline the pre-procedural workup of TAVI patients.
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Affiliation(s)
- Julia Mascherbauer
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Tanja Rudolph
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Justus T Strauch
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil Bochum, Ruhr university, Bochum, Germany
| | - Moritz Seiffert
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil Bochum, Ruhr university, Bochum, Germany
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine-Westphalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Philipp Emanuel Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Marie Zielinski
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Anjaly Vijayan
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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Caminiti R, Ielasi A, Vetta G, Parlavecchio A, Della Rocca DG, Pellegrini D, Pellicano M, Montonati C, Mancini N, Carciotto G, Ajello M, Iuvara G, Costa F, Laterra G, Barbanti M, Ceresa F, Patanè F, Micari A, Vizzari G. Percutaneous Coronary Intervention before or after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis Involving 1531 Patients. J Clin Med 2024; 13:3521. [PMID: 38930050 PMCID: PMC11204616 DOI: 10.3390/jcm13123521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The optimal timing to perform percutaneous coronary interventions (PCIs) in patients undergoing transcatheter aortic valve replacement (TAVR) is not well established. In this meta-analysis, we aimed to compare the outcomes of patients undergoing PCI before versus after TAVR. Methods: A comprehensive literature search was performed including Medline, Embase, and Cochrane electronic databases up to 5 April 2024 for studies that compared PCI before and after TAVR reporting at least one clinical outcome of interest (PROSPERO ID: CRD42023470417). The analyzed outcomes were mortality, stroke, and myocardial infarction (MI) at follow-up. Results: A total of 3 studies involving 1531 patients (pre-TAVR PCI n = 1240; post-TAVR PCI n = 291) were included in this meta-analysis following our inclusion criteria. Mortality was higher in the pre-TAVR PCI group (OR: 2.48; 95% CI: 1.19-5.20; p = 0.02). No differences were found between PCI before and after TAVR for the risk of stroke (OR: 3.58; 95% CI: 0.70-18.15; p = 0.12) and MI (OR: 0.66; 95% CI: 0.30-1.42; p = 0.29). Conclusions: This meta-analysis showed in patients with stable CAD undergoing TAVR that PCI after TAVR is associated with lower mortality compared with PCI before TAVR.
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Affiliation(s)
- Rodolfo Caminiti
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy; (R.C.); (A.I.); (D.P.); (M.P.); (C.M.)
- Divisione di Cardiologia–Emodinamica, Policlinico Madonna della Consolazione, 89124 Reggio Calabria, Italy
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy; (R.C.); (A.I.); (D.P.); (M.P.); (C.M.)
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium; (G.V.); (D.G.D.R.)
| | - Antonio Parlavecchio
- Interventional Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (A.P.); (G.C.); (M.A.); (G.I.); (F.C.); (A.M.)
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium; (G.V.); (D.G.D.R.)
| | - Dario Pellegrini
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy; (R.C.); (A.I.); (D.P.); (M.P.); (C.M.)
| | - Mariano Pellicano
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy; (R.C.); (A.I.); (D.P.); (M.P.); (C.M.)
| | - Carolina Montonati
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy; (R.C.); (A.I.); (D.P.); (M.P.); (C.M.)
| | - Nastasia Mancini
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60131 Ancona, Italy;
| | - Gabriele Carciotto
- Interventional Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (A.P.); (G.C.); (M.A.); (G.I.); (F.C.); (A.M.)
| | - Manuela Ajello
- Interventional Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (A.P.); (G.C.); (M.A.); (G.I.); (F.C.); (A.M.)
| | - Giustina Iuvara
- Interventional Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (A.P.); (G.C.); (M.A.); (G.I.); (F.C.); (A.M.)
| | - Francesco Costa
- Interventional Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (A.P.); (G.C.); (M.A.); (G.I.); (F.C.); (A.M.)
| | - Giulia Laterra
- Faculty of Medicine and Surgery, Università degli Studi di Enna “Kore”, 94100 Enna, Italy; (G.L.); (M.B.)
| | - Marco Barbanti
- Faculty of Medicine and Surgery, Università degli Studi di Enna “Kore”, 94100 Enna, Italy; (G.L.); (M.B.)
| | - Fabrizio Ceresa
- Department of Cardiothoracic Surgery, Papardo Hospital, 98158 Messina, Italy; (F.C.); (F.P.)
| | - Francesco Patanè
- Department of Cardiothoracic Surgery, Papardo Hospital, 98158 Messina, Italy; (F.C.); (F.P.)
| | - Antonio Micari
- Interventional Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (A.P.); (G.C.); (M.A.); (G.I.); (F.C.); (A.M.)
| | - Giampiero Vizzari
- Interventional Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (A.P.); (G.C.); (M.A.); (G.I.); (F.C.); (A.M.)
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Sammartino S, Laterra G, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Ribeiro HB, Saia F, Bunc M, Tchetche D, Garot P, Ribichini FL, Mylotte D, Burzotta F, Watanabe Y, Bedogni F, Tesorio T, Rheude T, Sardella G, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, De Marco F, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Comis A, Melfa C, Calì M, Sgroi C, Abdel-Wahab M, Stefanini G, Tamburino C, Barbanti M, Costa G. Characterization and Management of Stable Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:3497. [PMID: 38930026 PMCID: PMC11204567 DOI: 10.3390/jcm13123497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: To date, data regarding the characteristics and management of obstructive, stable coronary artery disease (CAD) encountered in patients undergoing transcatheter aortic valve implantation (TAVI) are sparse. The aim of the study was to analyze granular details, treatment, and outcomes of patients undergoing TAVI with obstructive, stable CAD from real-world practice. Methods: REVASC-TAVI (Management of myocardial REVASCularization in patients undergoing Transcatheter Aortic Valve Implantation with coronary artery disease) is an investigator-initiated, multicenter registry, which collected data from patients undergoing TAVI with obstructive stable CAD found during the pre-TAVI work-up. Results: A total of 2025 patients from 30 centers worldwide with complete follow-up were included in the registry. Most patients had single-vessel CAD (56.1%). An involvement of proximal coronary tracts was detected in 62.5% of cases, with 12.0% of patients having CAD in left main (LM). Most patients received percutaneous coronary intervention (PCI) (n = 1617, 79.9%), especially those with proximal CAD (90.4%). At 2 years, the rates of all-cause death [Kaplan-Meier (KM) estimates 20.1% vs. 18.8%, plog-rank = 0.86] and of the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure (KM estimates 29.7% vs. 27.5%, plog-rank = 0.82) did not differ between patients undergoing PCI and those who were not. Conclusions: Patients undergoing TAVI with obstructive CAD more commonly had a single-vessel disease and an involvement of proximal coronary tracts. They were commonly treated with PCI, with similar outcomes compared to those treated conservatively.
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Affiliation(s)
- Sofia Sammartino
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
| | | | - Thomas Pilgrim
- Bern University Hospital, Inselspital, 3010 Bern, Switzerland;
| | - Ignacio J. Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 1165 Copenhagen, Denmark;
| | - Won-Keun Kim
- Kerckhoff Heart Center, 61231 Bad Nauheim, Germany;
| | | | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia;
| | | | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Hôpital Jacques Cartier, Ramsay-Santé, 91300 Massy, France;
| | - Flavio Luciano Ribichini
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy;
| | | | - Francesco Burzotta
- Department of Cardiology, IRCSS Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo 173-8605, Japan;
| | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.B.); (R.V.)
| | - Tullio Tesorio
- Clinica Montevergine, GVM Care & Research, 48033 Mercogliano, Italy;
| | | | - Gennaro Sardella
- Division of Cardiology, Policlinico Umberto I, 00185 Roma, Italy; (G.S.); (M.T.)
| | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, 00185 Roma, Italy; (G.S.); (M.T.)
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, 80125 Napoli, Italy;
| | - Roberto Valvo
- Division of Cardiology, IRCSS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.B.); (R.V.)
| | - Mikko Savontaus
- Heart Center, Turku University Hospital, 20014 Turku, Finland;
| | - Hendrik Wienemann
- Faculty of Medicine, University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, 50923 Cologne, Germany;
| | - Italo Porto
- CardioThoracic and Vascular Department, San Martino Policlinico Hospital, 16132 Genova, Italy;
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), 90127 Palermo, Italy;
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, UOSA Cardiologia Interventistica, Policlinico Le Scotte, 53100 Siena, Italy;
| | - Alessandro Santo Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy;
| | - Markus Mach
- Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Azeem Latib
- Montefiore Medical Center, New York, NY 10461, USA;
| | - Luigi Biasco
- Azienda Sanitaria Locale di Ciriè, Chivasso e Ivrea, ASLTO4, 10034 Chivasso, Italy;
| | - Maurizio Taramasso
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, 8006 Zurich, Switzerland;
| | | | - Valentina Frittitta
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
| | - Elena Dipietro
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
| | - Claudia Reddavid
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
| | - Orazio Strazzieri
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
| | - Silvia Motta
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
| | - Alessandro Comis
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
| | - Chiara Melfa
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
| | - Mariachiara Calì
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (C.S.); (C.T.)
| | | | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (C.S.); (C.T.)
| | - Marco Barbanti
- Department of Cardiology, Università degli Studi di Enna “Kore”, Piazza dell’Università, 94100 Enna, Italy
| | - Giuliano Costa
- Department of Cardiology, University of Catania, 95124 Catania, Italy; (S.S.); (V.F.); (E.D.); (C.R.); (O.S.); (S.M.); (A.C.); (C.M.); (M.C.); (G.C.)
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Lopes V, Almeida PC, Moreira N, Ferreira LA, Teixeira R, Donato P, Gonçalves L. Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1163-1181. [PMID: 38780710 DOI: 10.1007/s10554-024-03140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.
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Affiliation(s)
- Vanessa Lopes
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
| | - Pedro Carvalho Almeida
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Nádia Moreira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Luís Amaral Ferreira
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Biomedical Imaging and Translation Research (CIBIT), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Univ Coimbra, Coimbra, Portugal
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14
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Persits I, Layoun H, Kondoleon NP, Spilias N, Badwan O, Sipko J, Yun JJ, Kalra A, Dykun I, Tereshchenko LG, Krishnaswamy A, Reed GW, Kapadia SR, Puri R. Impact of untreated chronic obstructive coronary artery disease on outcomes after transcatheter aortic valve replacement. Eur Heart J 2024; 45:1890-1900. [PMID: 38270189 DOI: 10.1093/eurheartj/ehae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/24/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND AIMS In transcatheter aortic valve replacement (TAVR) recipients, the optimal management of concomitant chronic obstructive coronary artery disease (CAD) remains unknown. Some advocate for pre-TAVR percutaneous coronary intervention, while others manage it expectantly. The aim of this study was to assess the impact of varying degrees and extent of untreated chronic obstructive CAD on TAVR and longer-term outcomes. METHODS The authors conducted a retrospective cohort study of TAVR recipients from January 2015 to November 2021, separating patients into stable non-obstructive or varying degrees of obstructive CAD. The major outcomes of interest were procedural all-cause mortality and complications, major adverse cardiovascular events, and post-TAVR unplanned coronary revascularization. RESULTS Of the 1911 patients meeting inclusion, 75%, 6%, 10%, and 9% had non-obstructive, intermediate-risk, high-risk, and extreme-risk CAD, respectively. Procedural complication rates overall were low (death 0.4%, shock 0.1%, extracorporeal membrane oxygenation 0.1%), with no difference across groups. At a median follow-up of 21 months, rates of acute coronary syndrome and unplanned coronary revascularization were 0.7% and 0.5%, respectively, in the non-obstructive population, rising in incidence with increasing severity of CAD (P < .001 for acute coronary syndrome/unplanned coronary revascularization). Multivariable analysis did not yield a significantly greater risk of all-cause mortality or major adverse cardiovascular events across groups. One-year acute coronary syndrome and unplanned coronary revascularization rates in time-to-event analyses were significantly greater in the non-obstructive (98%) vs. obstructive (94%) subsets (Plog-rank< .001). CONCLUSIONS Transcatheter aortic valve replacement can be performed safely in patients with untreated chronic obstructive CAD, without portending higher procedural complication rates and with relatively low rates of unplanned coronary revascularization and acute coronary syndrome at 1 year.
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Affiliation(s)
- Ian Persits
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | | - Nikolaos Spilias
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Sipko
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - James J Yun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | | - Iryna Dykun
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Larisa G Tereshchenko
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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15
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Eltchaninoff H, Durand E. Transfemoral aortic valve implantation and concomitant CAD: the jury is out. Eur Heart J 2024:ehae141. [PMID: 38819811 DOI: 10.1093/eurheartj/ehae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Affiliation(s)
- Helene Eltchaninoff
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Eric Durand
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
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16
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Cohen DJ, Omar W. Myocardial Infarction After TAVR: Much Ado About Nothing? JACC Cardiovasc Interv 2024; 17:1277-1279. [PMID: 38811109 DOI: 10.1016/j.jcin.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 05/31/2024]
Affiliation(s)
- David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA.
| | - Wally Omar
- Northwell Health, New Hyde Park, New York, USA; Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA. https://twitter.com/WallyOmarMD
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17
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Minten L, Bennett J, Otsuki H, Takahashi K, Fearon WF, Dubois C. Differential Effect of Aortic Valve Replacement for Severe Aortic Stenosis on Hyperemic and Resting Epicardial Coronary Pressure Indices. J Am Heart Assoc 2024; 13:e034401. [PMID: 38761080 PMCID: PMC11179829 DOI: 10.1161/jaha.124.034401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/23/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Coronary pressure indices to assess coronary artery disease are currently underused in patients with aortic stenosis due to many potential physiological effects that might hinder their interpretation. Studies with varying sample sizes have provided us with conflicting results on the effect of transcatheter aortic valve replacement (TAVR) on these indices. The aim of this meta-analysis was to study immediate and long-term effects of TAVR on fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs). METHODS AND RESULTS Lesion-specific coronary pressure data were extracted from 6 studies, resulting in 147 lesions for immediate change in FFR analysis and 105 for NHPR analysis. To investigate the long-term changes, 93 lesions for FFR analysis and 68 for NHPR analysis were found. Lesion data were pooled and compared with paired t tests. Immediately after TAVR, FFR decreased significantly (-0.0130±0.0406 SD, P: 0.0002) while NHPR remained stable (0.0003±0.0675, P: 0.9675). Long-term after TAVR, FFR decreased significantly (-0.0230±0.0747, P: 0.0038) while NHPR increased nonsignificantly (0.0166±0.0699, P: 0.0543). When only borderline NHPR lesions were considered, this increase became significant (0.0249±0.0441, P: 0.0015). Sensitivity analysis confirmed our results in borderline lesions. CONCLUSIONS TAVR resulted in small significant, but opposite, changes in FFR and NHPR. Using the standard cut-offs in patients with severe aortic stenosis, FFR might underestimate the physiological significance of a coronary lesion while NHPRs might overestimate its significance. The described changes only play a clinically relevant role in borderline lesions. Therefore, even in patients with aortic stenosis, an overtly positive or negative physiological assessment can be trusted.
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Affiliation(s)
- Lennert Minten
- Department of Cardiovascular Sciences Katholieke Universiteit Leuven Leuven Belgium
- Division of Cardiovascular Medicine Stanford University Palo Alto CA
| | - Johan Bennett
- Department of Cardiovascular Sciences Katholieke Universiteit Leuven Leuven Belgium
- Department of Cardiovascular Medicine University Hospitals Leuven (UZ Leuven) Leuven Belgium
| | - Hisao Otsuki
- Division of Cardiovascular Medicine Stanford University Palo Alto CA
| | - Kuniaki Takahashi
- Division of Cardiovascular Medicine Stanford University Palo Alto CA
| | - William F Fearon
- Division of Cardiovascular Medicine Stanford University Palo Alto CA
| | - Christophe Dubois
- Department of Cardiovascular Sciences Katholieke Universiteit Leuven Leuven Belgium
- Department of Cardiovascular Medicine University Hospitals Leuven (UZ Leuven) Leuven Belgium
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Avvedimento M, Campelo-Parada F, Nombela-Franco L, Fischer Q, Donaint P, Serra V, Veiga G, Gutiérrez E, Franzone A, Vilalta V, Alperi A, Regueiro A, Asmarats L, B Ribeiro H, Matta A, Muñoz-García A, Tirado G, Urena M, Metz D, Rodenas-Alesina E, de la Torre Hernández JM, Angellotti D, Fernández-Nofrerías E, Pascual I, Vidal-Calés P, Arzamendi D, Carter Campanha-Borges D, Hoang Trinh K, Nuche J, Côté M, Faroux L, Rodés-Cabau J. Clinical impact of complex percutaneous coronary intervention in the pre-TAVR workup. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00159-2. [PMID: 38763211 DOI: 10.1016/j.rec.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION AND OBJECTIVES In patients undergoing percutaneous coronary intervention (PCI) in the workup pre-transcatheter aortic valve replacement (TAVR), the clinical impact of coronary revascularization complexity remains unknown. This study sought to examine the impact of PCI complexity on clinical outcomes after TAVR in patients undergoing PCI in the preprocedural workup. METHODS This was a multicenter study including consecutive patients scheduled for TAVR with concomitant significant coronary artery disease. Complex PCI was defined as having at least 1 of the following features: 3 vessels treated, ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with 2 stents implanted, total stent length >60mm, or chronic total occlusion. The rates of major adverse cardiac events (MACE), including cardiovascular mortality, myocardial infarction, and coronary revascularization were evaluated. RESULTS A total of 1550 patients were included, of which 454 (29.3%) underwent complex PCI in the pre-TAVR workup. After a median follow-up period of 2 [1-3] years after TAVR, the incidence of MACE was 9.6 events per 100 patients-years. Complex PCI significantly increased the risk of cardiac death (HR, 1.44; 95%CI, 1.01-2.07), nonperiprocedural myocardial infarction (HR, 1.52; 95%CI, 1.04-2.21), and coronary revascularization (HR, 2.46; 95%CI, 1.44-4.20). In addition, PCI complexity was identified as an independent predictor of MACE after TAVR (HR, 1.31; 95%CI, 1.01-1.71; P=.042). CONCLUSIONS In TAVR candidates with significant coronary artery disease requiring percutaneous treatment, complex revascularization was associated with a higher risk of MACE. The degree of procedural complexity should be considered a strong determinant of prognosis in the PCI-TAVR population.
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Affiliation(s)
- Marisa Avvedimento
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Luis Nombela-Franco
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Quentin Fischer
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Donaint
- Cardiology Department, Reims University Hospital, Reims, France
| | - Vicenç Serra
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gabriela Veiga
- Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain
| | | | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Victoria Vilalta
- Servicio de Cardiología, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alberto Alperi
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Ander Regueiro
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Lluis Asmarats
- Servicio de Cardiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Henrique B Ribeiro
- Cardiology Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Anthony Matta
- Cardiology Department, Hôpital Universitaire de Toulouse, Toulouse, France
| | - Antonio Muñoz-García
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Gabriela Tirado
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Marina Urena
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Metz
- Cardiology Department, Reims University Hospital, Reims, France
| | | | | | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Isaac Pascual
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pablo Vidal-Calés
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Kim Hoang Trinh
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Reims, France
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
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19
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Kern MJ, Seto AH. Editorial: Does revascularization in TAVR patients make a difference? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00484-6. [PMID: 38763859 DOI: 10.1016/j.carrev.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Morton J Kern
- Long Beach Veteran's Administration Medical Center, 5901 East 7th Street, 111C, Long Beach, CA 90822n, United States of America.
| | - Arnold H Seto
- Long Beach Veteran's Administration Medical Center, 5901 East 7th Street, 111C, Long Beach, CA 90822n, United States of America
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20
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Damluji AA, Nanna MG, Rymer J, Kochar A, Lowenstern A, Baron SJ, Narins CR, Alkhouli M. Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series. JACC Cardiovasc Interv 2024; 17:961-978. [PMID: 38597844 PMCID: PMC11097960 DOI: 10.1016/j.jcin.2024.01.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 04/11/2024]
Abstract
Aging is the gradual decline in physical and physiological functioning leading to increased susceptibility to stressors and chronic illnesses, including cardiovascular disease. With an aging global population, in which 1 in 6 individuals will be older than 60 years by 2030, interventional cardiologists are increasingly involved in providing complex care for older individuals. Although procedural aspects remain their main clinical focus, interventionalists frequently encounter age-associated risks that influence eligibility for invasive care, decision making during the intervention, procedural adverse events, and long-term management decisions. The unprecedented growth in transcatheter interventions, especially for structural heart diseases at extremes of age, have pushed age-related risks and implications for cardiovascular care to the forefront. In this JACC state-of-the-art review, the authors provide a comprehensive overview of the aging process as it relates to cardiovascular interventions, with special emphasis on the difference between chronological and biological aging. The authors also address key considerations to improve health outcomes for older patients during and after their invasive cardiovascular care. The role of "gerotherapeutics" in interventional cardiology, technological innovation in measuring biological aging, and the integration of patient-centered outcomes in the older adult population are also discussed.
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Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research, Fairfax, Virginia, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael G Nanna
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Rymer
- Duke University School of Medicine, Durham, North Carolina USA
| | - Ajar Kochar
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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21
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Kurmani S, Modi B, Mukherjee A, Adlam D, Banning A, Ladwiniec A, Rajendra R, Baron J, Roberts E, Ng A, Squire I, McCann G, Samani NJ, Kovac J. Coronary artery disease and outcomes following transcatheter aortic valve implantation. Open Heart 2024; 11:e002620. [PMID: 38553013 PMCID: PMC11005701 DOI: 10.1136/openhrt-2024-002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
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.
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Affiliation(s)
- Sameer Kurmani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | | | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | | | | | | | | | - Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Glenfield Hospital, Leicester, UK
| | - Gerald McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jan Kovac
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Glenfield Hospital, Leicester, UK
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22
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Khoo JK, Sellers S, Fairbairn T, Polsani V, Liu S, Yong G, Shetty S, Corrigan F, Ko B, Vucic E, Fitzgibbons TP, Kakouros N, Blanke P, Sathananthan J, Webb J, Wood D, Leipsic J, Ihdayhid AR. Feasibility and Utility of Anatomical and Physiological Evaluation of Coronary Disease With Cardiac CT in Severe Aortic Stenosis (FUTURE-AS Registry): Rationale and Design. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101293. [PMID: 39131219 PMCID: PMC11308847 DOI: 10.1016/j.jscai.2023.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 08/13/2024]
Abstract
Background Coronary artery disease (CAD) in patients with severe aortic stenosis (AS) is common and may be associated with worse outcomes. Computed tomography coronary angiography (CTCA) and fractional flow reserve derived from computed tomography (FFRCT) are tools for comprehensive coronary assessment. The utility and safety of CTCA and FFRCT in the work-up for transcatheter aortic valve replacement (TAVR) is not established, especially in an evolving landscape that involves younger TAVR patients. The FUTURE-AS Registry will assess the utility and safety of cardiac-optimized CTCA and FFRCT to evaluate CAD and guide referral for downstream invasive coronary angiography (ICA) in patients with severe AS being considered for TAVR. Methods FUTURE-AS is an international, prospective, multicenter registry of patients with severe AS referred for TAVR being assessed for CAD with CTCA and FFRCT. The primary end point is the per-patient sensitivity and negative predictive value of CTCA and FFRCT for identifying anatomical and physiologically significant CAD compared to ICA and invasive FFR. The safety end point is the incidence of symptomatic hypotension or bradycardia requiring intervention following the administration of nitroglycerin or β-blocker medications. Feasibility end points include the incidence of noninterpretable CTCA scans and CTCA scans not adequate for FFR analysis. Other utility end points include specificity, positive predictive value, and accuracy of CTCA and FFRCT. Lastly, the potential of a CTCA and FFRCT guided strategy to defer pre-TAVR ICA will be assessed. Conclusions FUTURE-AS will characterize the utility, safety, and feasibility of CTCA and FFRCT for coronary assessment pre-TAVR.
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Affiliation(s)
- John King Khoo
- Department of Radiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - Stephanie Sellers
- Department of Radiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - Timothy Fairbairn
- Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Shizhen Liu
- Piedmont Heart Institute, Piedmont Healthcare, Atlanta, Georgia
| | - Gerald Yong
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Sharad Shetty
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Frank Corrigan
- Wellstar Center for Cardiovascular Care, Wellstar Health System, Marietta, Georgia
| | - Brian Ko
- Victorian Heart Hospital, Melbourne, Australia
| | | | | | | | - Philipp Blanke
- Department of Radiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - Janarthanan Sathananthan
- Department of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - John Webb
- Department of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - David Wood
- Department of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- Department of Radiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
- Department of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - Abdul Rahman Ihdayhid
- Department of Radiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
- Harry Perkins Institute of Medical Research, Curtin Medical School, Curtin University, Perth, Australia
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23
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Will M, Schwarz K, Weiss T, Leibundgut G, Schmidt E, Vock P, Mousavi R, Borovac JA, Kwok CS, Hoppe UC, Mascherbauer J, Lamm G. The impact of concomitant chronic total occlusion on clinical outcomes in patients undergoing transcatheter aortic valve replacement: a large single-center analysis. Front Cardiovasc Med 2024; 11:1338253. [PMID: 38464840 PMCID: PMC10921092 DOI: 10.3389/fcvm.2024.1338253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Coronary artery disease (CAD) is a common finding in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). However, the impact on prognosis of chronic total occlusions (CTOs), a drastic expression of CAD, remains unclear. Methods and results We retrospectively reviewed 1,487 consecutive TAVR cases performed at a single tertiary care medical center. Pre-TAVR angiograms were analyzed for the presence of a CTO. At the time of TAVR, 11.2% (n = 167) patients had a CTO. There was no significant association between the presence of a CTO and in-hospital or 30-day mortality. There was also no difference in long-term survival. LV ejection fraction and mean aortic gradients were lower in the CTO group. Conclusions Our analysis suggests that concomitant CTO lesions in patients undergoing TAVR differ in their risk profile and clinical findings to patients without CTO. CTO lesion per se were not associated with increased mortality, nevertheless CTOs which supply non-viable myocardium in TAVR population were associated with increased risk of death. Additional research is needed to evaluate the prognostic significance of CTO lesions in TAVR patients.
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Affiliation(s)
- Maximilian Will
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St Poelten, Austria
| | - Konstantin Schwarz
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Thomas Weiss
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St Poelten, Austria
- Medical School, Sigmund-Freud University, Vienna, Austria
| | - Gregor Leibundgut
- Klinik für Kardiologie, Universitätsspital Basel, Basel, Switzerland
| | - Elisabeth Schmidt
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Paul Vock
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Roya Mousavi
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Josip A Borovac
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia
| | - Chun Shing Kwok
- Department of Post-Qualifying Healthcare Practice, School of Nursing and Midwifery, Birmingham City University, Birmingham, United Kingdom
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Uta C Hoppe
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Julia Mascherbauer
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Gudrun Lamm
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
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24
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Parikh PB, Mack M, Stone GW, Anker SD, Gilchrist IC, Kalogeropoulos AP, Packer M, Skopicki HA, Butler J. Transcatheter aortic valve replacement in heart failure. Eur J Heart Fail 2024; 26:460-470. [PMID: 38297972 DOI: 10.1002/ejhf.3151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
Patients with severe aortic stenosis (AS) may develop heart failure (HF), the presence of which has traditionally been deemed as a final stage in AS progression with poor outcomes. The use of transcatheter aortic valve replacement (TAVR) has become the preferred therapy for most patients with AS and concomitant HF. With its instant afterload reduction, TAVR offers patients with HF significant haemodynamic benefits, with corresponding changes in left ventricular structure and improved mortality and quality of life. The prognostic covariates and optimal timing of TAVR in patients with less than severe AS remain unclear. The purpose of this review is to describe the association between TAVR and outcomes in patients with HF, particularly in the setting of left ventricular systolic dysfunction, acute HF, and right ventricular systolic dysfunction, and to highlight areas for future research.
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Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Michael Mack
- Department of Cardiac Surgery, Baylor Scott & White Health, Plano, TX, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ian C Gilchrist
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | | | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Hal A Skopicki
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Javed Butler
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
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25
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Hanson I, Goldstein JA. Percutaneous coronary intervention: Before, after, or during TAVR? Catheter Cardiovasc Interv 2024; 103:389-390. [PMID: 38140762 DOI: 10.1002/ccd.30941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
Key points
Decisions surrounding if, and when, to perform coronary revascularization in patients undergoing trans‐catheter aortic valve replacement (TAVR) are often complex.
Concomitant percutaneous coronary interventions (PCI) and TAVR is associated with comparable technical success, but higher rates of bleeding and acute kidney injury, compared to staged procedures or no PCI.
Timing of PCI relative to TAVR should be individualized based on clinical status, lesion complexity and anticipated risks of bleeding and renal injury.
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Affiliation(s)
- Ivan Hanson
- Department of Cardiovascular Medicine, Corewell Health Beaumont Hospital, Royal Oak, Michigan, USA
| | - James A Goldstein
- Department of Cardiovascular Medicine, Corewell Health Beaumont Hospital, Royal Oak, Michigan, USA
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26
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Del Portillo JH, Farjat-Pasos J, Galhardo A, Avvedimento M, Mas-Peiro S, Mengi S, Nuche J, Mohammadi S, Rodés-Cabau J. Aortic Stenosis With Coronary Artery Disease: SAVR or TAVR-When and How? Can J Cardiol 2024; 40:218-234. [PMID: 37758014 DOI: 10.1016/j.cjca.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
The growing number of candidates for transcatheter aortic valve replacement (TAVR) has increased the interest in the concomitant presence of coronary artery disease (CAD) and severe aortic stenosis (AS), prompting the need to define the appropriate revascularization strategy for each case. The reported prevalence of concurrent AS and CAD has varied over the years on the basis of the CAD definition and the population evaluated. Revascularization for treating CAD in patients with severe AS involves additional interventions that could impact outcomes. The addition of coronary artery bypass grafting (CABG) to surgical aortic valve replacement (SAVR) has demonstrated favourable effects on long-term prognosis, while the impact of adding percutaneous coronary intervention (PCI) to TAVR may depend on the CAD complexity and the feasibility of achieving complete or reasonably incomplete revascularization. Furthermore, the comparison between SAVR+CABG and TAVR+PCI in low-intermediate surgical risk and low-intermediate complex CAD patients did not reveal differences in all-cause mortality or stroke between the groups. However, there is some evidence showing a lower incidence of major cardiovascular events with the SAVR+CABG strategy for patients with complex CAD. Thus, SAVR+CABG seems to be the best option for patients with low-intermediate surgical risk and complex CAD, and TAVR+PCI for high surgical risk patients seeking complete and/or reasonable incomplete revascularization. After deciding between TAVR+PCI or SAVR+CABG, factors such as timing for PCI, low ejection fraction, coronary reaccess, and valve durability must be considered. Finally, alternative methods for assessing CAD severity are currently under evaluation to ascertain their real value for guiding revascularization in patients with severe AS with CAD.
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Affiliation(s)
| | - Julio Farjat-Pasos
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Attilio Galhardo
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Marisa Avvedimento
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Silvia Mas-Peiro
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siddhartha Mengi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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27
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Diaz Nuila ME, Gupta A, Alkhalil M. Single-access, non-contrast transcatheter aortic valve implantation, the ultimate minimalist approach: a case report. Eur Heart J Case Rep 2024; 8:ytae040. [PMID: 38332920 PMCID: PMC10852022 DOI: 10.1093/ehjcr/ytae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 01/07/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
Background Transcatheter aortic valve implantation (TAVI) is an established treatment for patients with symptomatic severe aortic stenosis. Patients with previous renal transplant are considered as a high-risk cohort who may develop procedural complications related to vascular access and renal impairment post-TAVI. Case summary Herein, we report a case of an 88-year-old male who presented with progressive dyspnoea. His transthoracic echocardiogram revealed severe aortic stenosis with a peak gradient of 75 mmHg and impaired left ventricle systolic function (an estimated ejection fraction of 40%). He had a background of kidney transplant with progressive decline in renal function, requiring the formation of left arm arteriovenous fistula in preparation for future dialysis. He was successfully treated with TAVI using a single vascular access site without administering contrast media. Discussion Single-access, non-contrast TAVI is feasible when treating renal transplant patients with severe aortic stenosis and limited vascular access. The current minimalistic approach should be used only in highly selective patient cases.
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Affiliation(s)
- Mario E Diaz Nuila
- Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne NE7 7DN, UK
| | - Ashish Gupta
- Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne NE7 7DN, UK
| | - Mohammed Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne NE7 7DN, UK
- Translational and Clinical Research Institute, Newcastle University, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK
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Moreno R, Souza J, Smolnik R, Nombela-Franco L, Van Mieghem NM, Hengstenberg C, Valgimigli M, Jin J, Ohlmann P, Dangas G, Unverdorben M, Möllmann H. Outcomes after TAVI in patients with atrial fibrillation and a history of recent PCI: Results from the ENVISAGE-TAVI AF trial. Clin Res Cardiol 2024:10.1007/s00392-024-02379-5. [PMID: 38294497 DOI: 10.1007/s00392-024-02379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and a recent (≤ 90 days) percutaneous coronary intervention (PCI) undergoing transcatheter aortic valve implantation (TAVI) are at high bleeding risk due to the addition of oral antiplatelet (OAP) agents on top of oral anticoagulants. Data on outcomes of these patients are needed to optimize antithrombotic treatment. METHODS This analysis compared annualized clinical event rates in patients with and without a recent PCI enrolled in ENVISAGE-TAVI AF, a prospective, randomized, open-label, adjudicator-masked trial comparing edoxaban and vitamin K antagonists in AF patients after TAVI. The primary efficacy and safety outcomes were net adverse clinical events (NACE) and major bleeding. RESULTS Overall, 132 (94.3%) patients with a recent PCI (n = 140) received OAP after TAVI, compared with 692 (55.9%) patients without a recent PCI (n = 1237). Among patients with a recent PCI on OAP agents, use of dual antiplatelet therapy decreased to 5.5%, and use of single antiplatelet therapy (SAPT) increased to 78.0% over 3 months post-randomization. Conversely, use of SAPT predominated at all time points in patients without a recent PCI history. There were no significant differences in the incidence of NACE or other outcomes assessed, except for major bleeding events, which were more frequent in patients with vs without a recent PCI history (hazard ratio [95% confidence interval]: 2.17 [1.27, 3.73]; P = 0.005). CONCLUSIONS Patients with AF undergoing TAVI with a recent PCI have a similar risk of ischemic events and mortality, but an increased risk of major bleeding compared with patients without a recent PCI.
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Affiliation(s)
- Raúl Moreno
- Interventional Cardiology, University Hospital La Paz, Paseo La Castellana, 261, 28046, Madrid, Spain.
| | | | | | | | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University, Vienna, Austria
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Università Della Svizzera Italiana (USI) and University of Berne, Berne, Switzerland
| | - James Jin
- Daiichi Sankyo, Inc, Basking Ridge, NJ, USA
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, University Hospital of Strasbourg, Strasbourg, France
| | - George Dangas
- Mount Sinai Hospital, Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Helge Möllmann
- Department of Internal Medicine, St. Johannes Hospital, Dortmund, Germany
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29
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Diller GP, Gerwing M, Boroni Grazioli S, De-Torres-Alba F, Radke RM, Vormbrock J, Baumgartner H, Kaleschke G, Orwat S. Utility of Coronary Computed Tomography Angiography in Patients Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis and Meta-Regression Based on Published Data from 7458 Patients. J Clin Med 2024; 13:631. [PMID: 38276138 PMCID: PMC10816478 DOI: 10.3390/jcm13020631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Coronary CT angiography (CCTA) may detect coronary artery disease (CAD) in transcatheter aortic valve implantation (TAVI) patients and may obviate invasive coronary angiography (ICA) in selected patients. We assessed the diagnostic accuracy of CCTA for detecting CAD in TAVI patients based on published data. METHODS Meta-analysis and meta-regression were performed based on a comprehensive electronic search, including relevant studies assessing the diagnostic accuracy of CCTA in the setting of TAVI patients compared to ICA. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated on a patient and per segment level. RESULTS Overall, 27 studies (total of 7458 patients) were included. On the patient level, the CCTA's pooled sensitivity and NPV were 95% (95% CI: 93-97%) and 97% (95% CI: 95-98%), respectively, while the specificity and PPV were at 73% (95% CI: 62-82%) and 64% (95% CI: 57-71%), respectively. On the segmental coronary vessel level, the sensitivity and NPV were 90% (95% CI: 79-96%) and 98% (95% CI: 97-99%). CONCLUSIONS This meta-analysis highlights CCTA's potential as a first-line diagnostic tool although its limited PPV and specificity may pose challenges when interpreting heavily calcified arteries. This study underscores the need for further research and protocol standardization in this area.
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Affiliation(s)
- Gerhard-Paul Diller
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Mirjam Gerwing
- Clinic of Radiology, University Hospital Muenster, 48149 Muenster, Germany
| | - Simona Boroni Grazioli
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Fernando De-Torres-Alba
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Robert M. Radke
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Julia Vormbrock
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Helmut Baumgartner
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Gerrit Kaleschke
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Stefan Orwat
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
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30
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Fischer J, Steffen J, Arlart T, Haum M, Gschwendtner S, Doldi PM, Rizas K, Theiss H, Braun D, Orban M, Peterß S, Hausleiter J, Massberg S, Deseive S. Concomitant percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2024; 103:186-193. [PMID: 38140761 DOI: 10.1002/ccd.30927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Patients undergoing transcatheter aortic valve implantation (TAVI) frequently have coronary artery disease requiring percutaneous coronary intervention (PCI). Usually, PCI and TAVI are performed in two separate procedures and current studies are investigating potential benefits regarding the order. However, the two interventions may also be performed simultaneously, thereby limiting the risk associated with repeated vascular access. Data evaluating benefit and harm of concomitant procedures are scarce. AIMS Therefore, this study aimed to evaluate concomitant PCI (coPCI) in TAVI patients regarding Valve Academic Research Consortium 3 (VARC-3) endpoints and long-term mortality. METHODS A total of 2233 consecutive TAVI patients from the EVERY-VALVE registry were analyzed according to the VARC-3 endpoint definitions. A total of 274 patients had undergone TAVI and concomitant PCI (coPCI group). They were compared to 226 TAVI patients who had received PCI within 60 days before TAVI in a stepwise approach (swPCI group) and to the remaining 1733 TAVI patients who had not undergone PCI recently (noPCI group). RESULTS Overall median age was 81.4 years, median Society of Thoracic Surgeons score was 4.0%. Patients in the coPCI and in the swPCI group were predominantly male with reduced left-ventricular ejection fraction. Rates of VARC-3 composite endpoints technical success and 30-day device success were comparable between all three groups. Mortality rates at 3 years after TAVI were similar (coPCI, 34.2% vs. swPCI, 31.9% vs. noPCI, 34.0% p = 0.84). CONCLUSIONS coPCI during TAVI seems comparable in a retrospective analysis. Compared to a stepwise approach, it has similar rates of composite endpoints technical success and device success as well as long-term mortality.
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Affiliation(s)
- Julius Fischer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Tobias Arlart
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Sarah Gschwendtner
- Zentrale Notaufnahme und Aufnahmestation, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin, Berlin, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Sven Peterß
- Department of Heart Surgery, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
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31
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Zivkovic M, Tomovic S, Busic I, Zivic K, Vukcevic V, Wojakowski W, Binder RK, Banovic M. Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement. Curr Probl Cardiol 2024; 49:102016. [PMID: 37544628 DOI: 10.1016/j.cpcardiol.2023.102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Extending the indication of transcatheter aortic valve replacement (TAVR) to younger and lower-risk patients naturally results in longer life expectancy and survival rates after the intervention. The longer life expectancy of these patients leads to an increased possibility of future acute coronary events, necessitating the development of effective and appropriate treatment strategies. Acute coronary syndromes (ACS) in patients with previous TAVR procedures present with modified clinical characteristics when compared to the non-TAVR population. In populations with prior TAVR procedures, plaque rupture remains the main cause of ACS. However, unlike the non-TAVR population, there is an increased frequency of nonatherotrombotic mechanisms, like emboli and mechanical obstruction of coronary ostia by valve components. The main observation related to the treatment of ACS TAVR patients is the significantly lower percentage of patients undergoing invasive management. Furthermore, ACS in TAVR patients is associated with poor prognosis, higher long-term mortality rates, and higher incidence of MACE. It is surprising that considering this significant and increasingly recognized issue, there are only a few studies that have investigated ACS after TAVR. The scope of the present review is to address available data about ACS following TAVR, focusing on incidence, timing, mechanism, and causes. We also examined current knowledge regarding optimal invasive treatment and analyzed short and long-term clinical outcomes.
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Affiliation(s)
- Milorad Zivkovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sara Tomovic
- Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Busic
- Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Katarina Zivic
- Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Vladan Vukcevic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia; Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ronald K Binder
- Department of Internal Medicine II, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Marko Banovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia; Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia.
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Park DY, Simonato M, Ahmad Y, Banks AZ, Lowenstern A, Nanna MG. Insight Into the Optimal Timing of Percutaneous Coronary Intervention and Transcatheter Aortic Valve Replacement. Curr Probl Cardiol 2024; 49:102050. [PMID: 37643698 PMCID: PMC10924682 DOI: 10.1016/j.cpcardiol.2023.102050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
Patients being considered for transcatheter aortic valve replacement (TAVR) are frequently diagnosed with coronary artery disease. In patients requiring revascularization, there is a paucity of data informing when to perform percutaneous coronary artery intervention (PCI). We evaluated the impact of PCI timing on clinical outcomes and readmissions after TAVR. From the National Readmissions Database 2016 to 2019, we stratified the duration between PCI and TAVR into 3 groups: same-day PCI and TAVR, TAVR ≤30 days after PCI, and TAVR >30 days after PCI. We then compared primary and secondary outcomes among them. A total of 5207 patients were included, 1413 (27.1%) of whom underwent PCI and TAVR on the same day, while 2161 (41.5%) underwent TAVR ≤30 days after PCI, and 1632 (31.3%) underwent TAVR >30 days after PCI. There was no significant difference for in-hospital mortality among the groups (adjusted odds ratio [aOR] 0.49, 95% confidence interval [CI] 0.16-1.48, p = 0.203 for same-day versus ≤30 days; aOR 2.07, 95% CI 0.68-6.30, p = 0.199 for same-day versus >30 days). Patients who underwent TAVR ≤30 days after PCI had higher odds of acute kidney injury (aOR 1.49, 95% CI 1.05-2.10, p = 0.024), nonhome discharge (aOR 1.53, 95% CI 1.20-1.96, p = 0.001), and 90-day readmission (aOR 1.35, 95% CI 1.04-1.76, p = 0.026) compared with those who underwent same-day PCI and TAVR. Concomitant PCI and TAVR was associated with lower rates of 90-day readmissions and acute kidney injury compared with TAVR shortly after PCI (<30 days) and should be considered in select patients.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL
| | | | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Adam Z Banks
- Division of Cardiology, Presbyterian Hospital, Albuquerque, NM
| | - Angela Lowenstern
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.
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Zghouzi M, Osman H, Erdem S, Ullah W, Patel N, Sattar Y, Aronow H, Paul T, Aggarwal V, Licha H, Gurm H, Fischman D, Mamas M, AlJaroudi W, Alraies MC. In-Hospital Outcomes of Combined Coronary Revascularization and Transcatheter Aortic Valve Implantation in Inpatient Nationwide Analysis. Curr Probl Cardiol 2024; 49:101913. [PMID: 37557942 DOI: 10.1016/j.cpcardiol.2023.101913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is accepted as an alternative to surgery, but data on combined percutaneous coronary interventions (PCI) and TAVI during the same in-hospital stay are still lacking. Using the national inpatient sample (NIS) database, we identified all TAVI encounters and compared in-hospital outcomes of patients who had TAVI only to patients who had TAVI and PCI. We used multivariable logistic regression analysis to calculate the adjusted odds ratio (aOR). Of 291,810 patient encounters with TAVI, 13,114 (4.5%) had combined PCI during the same index admission. The average age was 79.61 ± 8.61 years in the TAVI-only vs 80.25 ± 8.73 years in the combined TAVI-PCI group. Combined TAVI and PCI was associated with higher in-hospital mortality (4.5% vs 1.8%, aOR: 2.3), stroke (4.7% vs 2.9%, aOR: 1.4), net adverse events (NAE) (20.2% vs 5.7%, aOR: 3.6), major bleeding (40.1% vs 24.3%, aOR: 1.8), vascular complications (10.6% vs 2.5%, aOR: 3.9), acute kidney injury (AKI) (23.3% vs 11.7%, aOR: 2.1), hemodialysis (HD) (4.2% vs 2.4%, aOR: 1.4), postoperative cardiogenic shock (1.2% vs 0.4%, aOR: 2.8), need for mechanical circulatory support (6.9% vs 1%, aOR: 7); p-value < 0.001 for all. The utilization of permanent pacemakers was similar between the groups (9.8% vs 9.2%, aOR: 1; p = 0.6). Combining TAVI and PCI during the same index admission is associated with worse outcomes. The decision to do PCI for patients undergoing TAVI should be individualized and tailored based on the patient's clinical conditions.
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Affiliation(s)
| | | | | | - Waqas Ullah
- Thomas Jefferson University, Philadelphia, PA
| | - Neel Patel
- New York Medical College/Landmark Medical Center, Woonsocket, RI
| | | | | | | | | | | | | | | | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Wael AlJaroudi
- Medical College of Georgia at Augusta University, Augusta, GA
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Park DY, An S, Arif AW, Saini A, Golzar Y. Impact of same-admission percutaneous coronary intervention on periprocedural outcomes of transcatheter aortic valve implantation. Proc AMIA Symp 2023; 37:7-13. [PMID: 38174009 PMCID: PMC10761096 DOI: 10.1080/08998280.2023.2273742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/09/2023] [Indexed: 01/05/2024] Open
Abstract
Background Current guidelines recommend percutaneous coronary intervention (PCI) prior to transcatheter aortic valve implantation (TAVI) if significant coronary artery disease is present, but whether PCI should be done in the same admission as TAVI is not determined. Methods We retrospectively analyzed the National Inpatient Sample from 2016 to 2019 to compare TAVI with and without same-admission PCI and compare in-hospital outcomes after propensity score matching. Results Among 170,030 hospitalizations for TAVI, 4425 (2.6%) had same-admission PCI performed. After propensity score matching, 4425 hospitalizations were allocated to those with and without same-admission PCI. No difference in in-hospital mortality (odds ratio [OR] 1.59, 95% confidence interval [CI] 0.81-3.12) was observed between the two groups. However, TAVI with same-admission PCI was associated with higher odds of cardiac arrest (OR 2.25, 95% CI 1.02-4.98), cardiogenic shock (OR 2.21, 95% CI 1.29-3.79), and acute myocardial infarction (OR 3.23, 95% CI 2.11-4.93). It was also associated with longer length of stay and more expensive hospital cost. Conclusion TAVI with same-admission PCI was associated with higher odds of periprocedural complications and higher immediate cost. Our findings should be interpreted in the context of the same-admission PCI and TAVI cohort potentially being sicker and the isolated TAVI control group may or may not having obstructive coronary artery disease.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Seokyung An
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Abdul Wahab Arif
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Abhimanyu Saini
- Division of Cardiology, Cook County Health, Chicago, Illinois, USA
- Division of Cardiology, Rush Medical College, Chicago, Illinois, USA
| | - Yasmeen Golzar
- Division of Cardiology, Cook County Health, Chicago, Illinois, USA
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Bansal K, Soni A, Shah M, Kosinski AS, Gilani F, Khera S, Vemulapalli S, Elmariah S, Kolte D. Association Between Polyvascular Disease and Transcatheter Aortic Valve Replacement Outcomes: Insights From the STS/ACC TVT Registry. Circ Cardiovasc Interv 2023; 16:e013578. [PMID: 37870587 DOI: 10.1161/circinterventions.123.013578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Atherosclerotic cardiovascular disease is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Polyvascular disease (PVD), defined as involvement of ≥2 vascular beds (VBs), that is, coronary, cerebrovascular, or peripheral, portends a poor prognosis in patients with atherosclerotic cardiovascular disease; however, data on the association of PVD with outcomes of patients undergoing TAVR are limited. METHODS The Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy Registry was analyzed to identify patients who underwent TAVR from November 2011 to March 2022. The exposure of interest was PVD. The primary outcome was all-cause mortality. Secondary outcomes included major vascular complications, major/life-threatening bleeding, myocardial infarction, transient ischemic attack/stroke, and valve- and non-valve-related readmissions. Outcomes were assessed at 30 days and 1 year. RESULTS Of 443 790 patients who underwent TAVR, PVD was present in 150 823 (34.0%; 111 425 [25.1%] with 2VB-PVD and 39 398 [8.9%] with 3VB-PVD). On multivariable analysis, PVD was associated with increased all-cause mortality at 1 year (hazard ratio, 1.17 [95% CI, 1.14-1.20]). There was an incremental increase in 1-year mortality with an increasing number of VBs involved (no PVD [reference]; 2VB-PVD: hazard ratio, 1.12 [95% CI, 1.09-1.15]: and 3VB-PVD: hazard ratio, 1.31 [95% CI, 1.26-1.36]). Patients with versus without PVD had higher rates of major vascular complications, major/life-threatening bleeding, transient ischemic attack/stroke, and non-valve-related readmissions at 30 days and 1 year. CONCLUSIONS PVD is associated with worse outcomes after TAVR, and the risk is highest in patients with 3VB-PVD.
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Affiliation(s)
- Kannu Bansal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (K.B., A.S.)
| | - Aakriti Soni
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (K.B., A.S.)
| | - Miloni Shah
- Duke Clinical Research Institute, Durham, NC (M.S., A.S.K.)
| | | | - Fahad Gilani
- Division of Cardiovascular Medicine, Catholic Medical Center, Manchester, NH (F.G.)
| | - Sahil Khera
- Division of Interventional Cardiology, Mount Sinai Hospital, New York, NY (S.K.)
| | - Sreekanth Vemulapalli
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (S.V.)
- Division of Cardiology, Duke University Medical Center, Durham, NC (S.V.)
| | - Sammy Elmariah
- Division of Cardiology, University of California, San Francisco (S.E.)
| | - Dhaval Kolte
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston (D.K.)
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Elderia A, Gerfer S, Eghbalzadeh K, Adam M, Baldus S, Rahmanian P, Kuhn E, Wahlers T. Surgical versus Interventional Treatment of Concomitant Aortic Valve Stenosis and Coronary Artery Disease. Thorac Cardiovasc Surg 2023; 71:620-631. [PMID: 36549305 DOI: 10.1055/a-2003-2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is frequently diagnosed in patients with aortic valve stenosis. Treatment options include surgical and interventional approaches. We therefore analyzed short-term outcomes of patients undergoing either coronary artery bypass grafting with simultaneous aortic valve replacement (CABG + AVR) or staged percutaneous coronary intervention and transcatheter aortic valve implantation (PCI + TAVI). METHODS From all patients treated since 2017, we retrospectively identified 237 patients undergoing TAVI within 6 months after PCI and 241 patients undergoing combined CABG + AVR surgery. Propensity score matching was performed, resulting in 101 matched pairs. RESULTS Patients in the CABG + AVR group were younger compared with patients in the PCI + TAVI group (71.9 ± 4.9 vs 81.4 ± 3.6 years; p < 0.001). The overall mortality at 30 days before matching was higher after CABG + AVR than after PCI + TAVI (7.8 vs 2.1%; p = 0.012). The paired cohort was balanced for both groups regarding demographic variables and the risk profile (age: 77.2 ± 3.7 vs78.5 ± 2.7 years; p = 0.141) and EuroSCORE II (6.2 vs 7.6%; p = 0.297). At 30 days, mortality was 4.9% in the CABG + AVR group and 1.0% in the PCI + TAVI group (p = 0.099). Rethoracotomy was necessary in 7.9% in the CABG + AVR, while conversion to open heart surgery was necessary in 2% in the PCI + TAVI group. The need for new pacemaker was lower after CABG + AVR than after PCI + TAVI (4.1 vs 6.9%; p = 0.010). No paravalvular leak (PVL) was noted in the CABG + AVR group, while the incidence of moderate-to-severe PVL after PCI + TAVI was 4.9% (p = 0.027). CONCLUSION A staged interventional approach comprises a short-term survival advantage compared with combined surgery for management of CAD and aortic stenosis. However, PCI + TAVI show a significantly higher risk of atrioventricular block and PVL. Further long-term trials are warranted.
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Affiliation(s)
- Ahmed Elderia
- Department of Cardiothoracic Surgery, University of Cologne, Heart Center, Cologne, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, University of Cologne, Heart Center, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University of Cologne, Heart Center, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, University of Cologne, Heart Center, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, University of Cologne, Heart Center, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, University of Cologne, Heart Center, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, University of Cologne, Heart Center, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University of Cologne, Heart Center, Cologne, Germany
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Faroux L, Villecourt A, Metz D. The Management of Coronary Artery Disease in TAVR Patients. J Clin Med 2023; 12:7126. [PMID: 38002738 PMCID: PMC10672348 DOI: 10.3390/jcm12227126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
About half of the transcatheter aortic valve replacement (TAVR) recipients exhibit some degree of coronary artery disease (CAD), and controversial results have been reported regarding the impact of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on the use of both cardiac computed tomography angiography and the functional invasive assessment of coronary lesions whether by FFR or iFR in the work-up pre-TAVR. Despite mitigated available data, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Additionally, scarce data exists on the incidence, characteristics and management of coronary events post-TAVR, and increasing interest exists on the potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the knowledge of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management.
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Affiliation(s)
- Laurent Faroux
- Cardiology Department, Reims University Hospital, 51100 Reims, France
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Aurigemma C, Massussi M, Fraccaro C, Adamo M, D'Errigo P, Rosato S, Seccareccia F, Santoro G, Baiocchi M, Barbanti M, Biancari F, Baglio G, Marcellusi A, Trani C, Tarantini G. Impact of Chronic Coronary Artery Disease and Revascularization Strategy in Patients with Severe Aortic Stenosis Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 206:14-22. [PMID: 37677878 DOI: 10.1016/j.amjcard.2023.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/09/2023]
Abstract
The prognostic impact of coronary artery disease (CAD) after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study is to investigate the impact of CAD and different revascularization strategies on clinical outcomes in patients who underwent TAVI with third generation devices. Patients enrolled in the national observational Observational Study of Effectiveness of SAVR-TAVI Procedures for Severe Aortic Stenosis Treatment II study were stratified according to the presence of CAD (CAD+, n = 1,130) versus no CAD (CAD-, n = 1,505), and compared using a propensity matched analysis. CAD+ group was further stratified according to the revascularization strategy: no revascularization (n = 331), revascularization performed >90 days before index-TAVI (n = 417) and coronary revascularization performed <90 days before index-TAVI or during TAVI (n = 382). In-hospital, 30-day and 1-year clinical outcomes were estimated. The mean age of the overall population was 81.8 years; 54.9% of patients were female. Propensity score matching yielded 813 pairs and their 30-day all-cause mortality was comparable (p = 0.480). Major periprocedural adverse events were also similar between the groups. At 1-year follow-up, the rate of major adverse cardiac and cerebrovascular events (MACCEs) and all-cause mortality were similar between the groups (p = 0.732 and p = 0.633, respectively). Conversely, patients with CAD experienced more often myocardial infarction and need for percutaneous coronary intervention at 1 year (p = 0.007 and p = 0.001, respectively). Neither CAD nor revascularization strategy were independent predictors of 1-year MACCE. About 40% of patients presenting with severe AS and who underwent TAVI had concomitant CAD. The presence of CAD had no impact on all-cause mortality and MACCE 1-year after TAVR. However, CAD carries a higher risk for acute myocardial infarction and need of percutaneous coronary intervention during follow-up.
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Affiliation(s)
- Cristina Aurigemma
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Mauro Massussi
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Chiara Fraccaro
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Gennaro Santoro
- Fondazione "G. Monasterio" CNR/Regione Toscana per la Ricerca Medica e la Sanità Pubblica, Massa, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Fausto Biancari
- Department of Internal Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA-CEIS), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Greco A, Capodanno D. Coronary Artery Disease and Transcatheter Aortic Valve Implantation: Unanswered Questions and Puzzling Pathways. Am J Cardiol 2023; 206:336-338. [PMID: 37739909 DOI: 10.1016/j.amjcard.2023.08.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 08/26/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Antonio Greco
- Cardiovascular Department, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco," University of Catania, Catania, Italy.
| | - Davide Capodanno
- Cardiovascular Department, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco," University of Catania, Catania, Italy
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Mosleh W, Mather JF, Delago AJ, Eastman L, Crain N, Swann EL, Masih R, DeVries JT, McKay RG, Young MN. The Benefit of Percutaneous Coronary Intervention Before Transcatheter Aortic Valve Replacement: A Multicenter Retrospective Outcome-Based Study. Am J Cardiol 2023; 206:175-184. [PMID: 37708748 DOI: 10.1016/j.amjcard.2023.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 09/16/2023]
Abstract
There is inadequate evidence regarding the role of percutaneous coronary intervention (PCI) in patients who underwent transcatheter aortic valve replacement (TAVR). The current American Heart Association/American College of Cardiology guidelines are limited to class 2A recommendations for pre-TAVR revascularization in the setting of hemodynamically significant left main (LM), proximal left anterior descending (pLAD), or extensive bifurcation disease regardless of angina status. We performed a multicenter, retrospective, observational study assessing the benefit of PCI in patients with coronary artery disease who underwent transfemoral TAVR for severe symptomatic aortic stenosis. Patients were divided into 2 cohorts: (1) patients who did not undergo pre-TAVR PCI within the preceding 12 months (no-PCI group) and (2) patients who received pre-TAVR PCI within the preceding 12 months (PCI group). The primary outcome was defined as the composite end point of in-hospital and 30-day adverse events, including all-cause mortality, cardiac arrest, and myocardial infarction. Subgroup analyses were performed on patients with LM and/or pLAD disease and other high-risk features, including angina and heart failure. Comparisons were made between 1,809 consecutive patients (1,364 in the no-PCI group and 445 in the PCI group). There were no differences between the 2 cohorts regarding the primary composite outcome (2.0% vs 2.8%, p = 0.918) or individual secondary outcomes. Although LM/pLAD disease, New York Heart Association classes III to IV, and Society of Thoracic Surgeons risk score ≥8 were all independent predictors of the primary outcome, none of the subgroups demonstrated a benefit favoring PCI. In conclusion, there is no observed benefit from PCI within 12 months pre-TAVR in patients with severe aortic stenosis and concomitant coronary artery disease, including patients with LM/pLAD disease.
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Affiliation(s)
- Wassim Mosleh
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Augustin J Delago
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Lauren Eastman
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nathan Crain
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Emily L Swann
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Rohit Masih
- Cardiology, Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - James T DeVries
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Raymond G McKay
- Cardiology, Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael N Young
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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Srinivasan S, Novelli A, Callas P, Gupta T, Straight F, Dauerman HL. Cardiac catheterization, coronary intervention, and wait times for transcatheter aortic valve replacement. Coron Artery Dis 2023; 34:475-482. [PMID: 37799044 DOI: 10.1097/mca.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Prolonged wait times for transcatheter aortic valve replacement (TAVR) are associated with increased morbidity and mortality. The incidence and predictors of short TAVR wait times (STWT: defined as ≤ 30 days from referral to TAVR procedure) have not been defined. This study examined the impact of clinical characteristics, demographics, and pre-TAVR cardiac catheterization on wait times for TAVR. METHODS This was a retrospective observational analysis of 831 patients with severe aortic stenosis undergoing TAVR from 2019 to mid-2022 at the University of Vermont Medical Center. Demographics, timing of treatment [stratified by COVID-19 onset (1 March 2020)], TAVR center travel distance, baseline clinical factors, and process-related variables were analyzed to determine univariate STWT predictors (P < 0.10). Multivariable analysis was performed to determine independent STWT predictors. RESULTS Approximately 50% of TAVR patients in this study achieved a STWT. The proportion of patients with STWT was higher (54.7% vs. 45.2%; P = 0.008) after the onset of COVID-19 pandemic. STWT was not related to travel distance (P = 0.61). Patients with left ventricular ejection fraction (LVEF) > 60% were less likely to achieve STWT compared to patients with LVEF < 40% (OR 0.45, P = 0.003). Patients who required catheterization or percutaneous coronary intervention (PCI) before TAVR were significantly less likely to achieve STWT (OR 0.65, P = 0.01). CONCLUSION TAVR wait times were not affected by the COVID-19 pandemic or single rural TAVR center travel distance. Sicker patients were more likely to achieve STWT while catheterization/PCI before TAVR was associated with longer wait times.
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Affiliation(s)
| | - Alexandra Novelli
- Department of Medicine, University of Vermont Larner College of Medicine
| | - Peter Callas
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Tanush Gupta
- Department of Medicine, University of Vermont Larner College of Medicine
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Faye Straight
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Harold L Dauerman
- Department of Medicine, University of Vermont Larner College of Medicine
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
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Yassen M, Moustafa A, Venkataramany B, Schodowski E, Royfman R, Eltahawy E. Clinical Outcomes of Transcatheter Aortic Valve Replacement With and Without Percutaneous Coronary Intervention-An Updated Meta-Analysis and Systematic Review. Curr Probl Cardiol 2023; 48:101980. [PMID: 37473936 DOI: 10.1016/j.cpcardiol.2023.101980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is indicated for high-risk patients with severe degenerative aortic stenosis (AS). Given the shared risk factors and coexistence of obstructive coronary artery disease (CAD) and AS, there is inconsistent clinical data regarding potential survival benefits of paired percutaneous coronary intervention (PCI) with TAVR procedures. We performed a literature search using PubMed, Embase, and Cochrane Library from inception through June 2023 assessing the impact of concomitant PCI in patients with obstructive CAD undergoing TAVR. The primary outcomes were 30-day all-cause mortality, 30-day cardiovascular mortality, and 6 months-1 year all-cause mortality. Secondary outcomes included 30-day myocardial infarction, stroke, major bleeding complications, and acute kidney injury (AKI). A total of 11 studies involving 2804 patients were included in the final analysis. Compared to patients undergoing TAVR alone, the TAVR+PCI group showed no significant difference in 30-day all-cause mortality (RR 0.90, CI 0.66, 1.22, P = 0.49), 30-day cardiovascular mortality (RR 0.71 CI 0.44, 1.14, P = 0.16), or 6 months-1 year all-cause mortality (RR 0.94, CI 0.75, 1.18, P = 0.57). Regarding secondary outcomes, 30-day myocardial infarction was higher in the TAVR+PCI group (RR 3.09, CI 1.26, 7.57, P = 0.01), with no significant differences noted in rates of 30-day stroke (RR 1.14, CI 0.56, 2.33, P = 0.72), major bleeding/vascular complications (RR 1.11, CI 0.79, 1.56, P = 0.55), and AKI (RR 1.07, CI 0.75, 1.54, P = 0.71). Concomitant PCI does not confer any mortality benefit in patients with obstructive CAD and high-grade AS undergoing TAVR. Further trials are needed to confirm our findings.
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Affiliation(s)
- Mohammad Yassen
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States.
| | - Abdelmoniem Moustafa
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Barat Venkataramany
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio, United States
| | - Eve Schodowski
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio, United States
| | - Rachel Royfman
- University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio, United States
| | - Ehab Eltahawy
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
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An KR, Gaudino MFL. How should we manage complex coronary disease during transcatheter aortic valve implantation? Indian J Thorac Cardiovasc Surg 2023; 39:568-569. [PMID: 37885928 PMCID: PMC10597952 DOI: 10.1007/s12055-023-01573-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Kevin R. An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68Th St, New York, NY 10065 USA
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Mario F. L. Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68Th St, New York, NY 10065 USA
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44
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Dobesh PP, Goldsweig AM. Antithrombotic therapy with Transcatheter aortic valve replacement. Pharmacotherapy 2023; 43:1064-1083. [PMID: 37464970 DOI: 10.1002/phar.2847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 07/20/2023]
Abstract
Aortic valve replacement is a necessary management strategy for patients with severe aortic stenosis. The use of transaortic valve replacement (TAVR) has increased significantly over the last decade and now exceeds traditional surgical aortic valve replacement. Since the valve systems used in TAVR consist of bioprosthetic valve tissue encased in a metal stent frame, antithrombotic therapy recommendations cannot be extrapolated from prior data with differently constructed surgical bioprosthetic or mechanical valves. Data on the use of antithrombotic therapy with TAVR are a rapidly developing area of medicine. Choice of agents depends on several patient factors. Patients undergoing TAVR also have a relatively high incidence of subclinical valve thrombosis. The clinical impact of this phenomenon and the implications for antithrombotic therapy continue to evolve. It is critical for clinicians who treat patients undergoing TAVR to have a firm understanding of practice guidelines, the evolving evidence, and its implications for the use of antithrombotic therapy in these patients.
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Affiliation(s)
- Paul P Dobesh
- Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew M Goldsweig
- Cardiac Catheterization Laboratory, Cardiovascular Clinical Research, Baystate Medical Center, Springfield, Massachusetts, USA
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Fezzi S, Ding D, Scarsini R, Huang J, Del Sole PA, Zhao Q, Pesarini G, Simpkin A, Wijns W, Ribichini F, Tu S. Integrated Assessment of Computational Coronary Physiology From a Single Angiographic View in Patients Undergoing TAVI. Circ Cardiovasc Interv 2023; 16:e013185. [PMID: 37712285 DOI: 10.1161/circinterventions.123.013185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Angiography-derived computational physiology is an appealing alternative to pressure-wire coronary physiology assessment. However, little is known about its reliability in the setting of severe aortic stenosis. This study sought to provide an integrated assessment of epicardial and microvascular coronary circulation by means of single-view angiography-derived physiology in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). METHODS Pre-TAVI angiographic projections of 198 stenotic coronary arteries (123 patients) were analyzed by means of Murray's law-based quantitative flow ratio and angiography microvascular resistance. Wire-based reference measurements were available for comparison: fractional flow reserve (FFR) in all cases, instantaneous wave-free ratio in 148, and index of microvascular resistance in 42 arteries. RESULTS No difference in terms of the number of ischemia-causing stenoses was detected between FFR ≤0.80 and Murray's law-based quantitative flow ratio ≤0.80 (19.7% versus 19.2%; P=0.899), while this was significantly higher when instantaneous wave-free ratio ≤0.89 (44.6%; P=0.001) was used. The accuracy of Murray's law-based quantitative flow ratio ≤0.80 in predicting pre-TAVI FFR ≤0.80 was significantly higher than the accuracy of instantaneous wave-free ratio ≤0.89 (93.4% versus 77.0%; P=0.001), driven by a higher positive predictive value (86.9% versus 50%). Similar findings were observed when considering post-TAVI FFR ≤0.80 as reference. In 82 cases with post-TAVI angiographic projections, Murray's law-based quantitative flow ratio values remained stable, with a low rate of reclassification of stenosis significance (9.9%), similar to FFR and instantaneous wave-free ratio. Angiography microvascular resistance demonstrated a significant correlation (Rho=0.458; P=0.002) with index of microvascular resistance, showing an area under the curve of 0.887 (95% CI, 0.752-0.964) in predicting index of microvascular resistance ≥25. CONCLUSIONS Angiography-derived physiology provides a valid, reliable, and systematic assessment of the coronary circulation in a complex scenario, such as severe aortic stenosis.
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Affiliation(s)
- Simone Fezzi
- Department of Medicine, Division of Cardiology, University of Verona, Italy (S.F., R.S., P.A.D.S., G.P., F.R.)
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, University of Galway, Ireland (S.F., D.D., J.H., W.W.)
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, University of Galway, Ireland (S.F., D.D., J.H., W.W.)
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (D.D., J.H., S.T.)
| | - Roberto Scarsini
- Department of Medicine, Division of Cardiology, University of Verona, Italy (S.F., R.S., P.A.D.S., G.P., F.R.)
| | - Jiayue Huang
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, University of Galway, Ireland (S.F., D.D., J.H., W.W.)
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (D.D., J.H., S.T.)
| | - Paolo Alberto Del Sole
- Department of Medicine, Division of Cardiology, University of Verona, Italy (S.F., R.S., P.A.D.S., G.P., F.R.)
| | - Qiang Zhao
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (Q.Z.)
| | - Gabriele Pesarini
- Department of Medicine, Division of Cardiology, University of Verona, Italy (S.F., R.S., P.A.D.S., G.P., F.R.)
| | - Andrew Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Ireland (A.S.)
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, University of Galway, Ireland (S.F., D.D., J.H., W.W.)
| | - Flavio Ribichini
- Department of Medicine, Division of Cardiology, University of Verona, Italy (S.F., R.S., P.A.D.S., G.P., F.R.)
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (D.D., J.H., S.T.)
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Rheude T, Costa G, Ribichini FL, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Ribeiro HB, Saia F, Bunc M, Tchétché D, Garot P, Mylotte D, Burzotta F, Watanabe Y, Bedogni F, Tesorio T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Xhepa E, Kargoli F, Tamburino C, Joner M, Barbanti M. Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2023; 19:589-599. [PMID: 37436190 PMCID: PMC10495747 DOI: 10.4244/eij-d-23-00186] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown. AIMS We sought to compare different PCI timing strategies in TAVI patients. METHODS The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method. RESULTS A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days. CONCLUSIONS In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.
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Affiliation(s)
- Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ignacio J Amat Santos
- CIBERCV, Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Matjaz Bunc
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Philippe Garot
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | | | - Francesco Burzotta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Tullio Tesorio
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | | | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Italo Porto
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Caterina Gandolfo
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda ospedaliera-universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Alessandro S Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | - Luigi Biasco
- Azienda Sanitaria Locale di Ciriè, Chivasso e Ivrea, ASL TO4, Ivrea, Italy
| | | | - Marco Zimarino
- Department of Cardiology, SS. Annunziata Hospital Chieti, ASL 2 Abruzzo, Chieti, Italy and Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | | | | | - Alexandre Gautier
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Galway University Hospital, Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Vincenzo De Marzo
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Elisa Piredda
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Stefano Cannata
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | | | | | | | | | | | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Erion Xhepa
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Michael Joner
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
- Università degli Studi di Enna "Kore", Enna, Italy
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Avvedimento M, Campelo-Parada F, Munoz-Garcia E, Nombela-Franco L, Fischer Q, Donaint P, Serra V, Veiga G, Gutiérrez E, Esposito G, Vilalta V, Alperi A, Regueiro A, Asmarats L, Ribeiro HB, Matta A, Munoz-Garcia A, Tirado-Conte G, Urena M, Metz D, Rodenas-Alesina E, de la Torre Hernandez JM, Fernandez-Nofrerias E, Pascual I, Vidal-Cales P, Arzamendi D, Campanha-Borges DC, Trinh KH, Côté M, Faroux L, Rodés-Cabau J. Late Bleeding Events in Patients Undergoing Percutaneous Coronary Intervention in the Workup Pre-TAVR. JACC Cardiovasc Interv 2023; 16:2153-2164. [PMID: 37704301 DOI: 10.1016/j.jcin.2023.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND In patients undergoing percutaneous coronary intervention (PCI) in the work-up pre-transcatheter aortic valve replacement (TAVR), the incidence and clinical impact of late bleeding events (LBEs) remain largely unknown. OBJECTIVES This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of LBEs in patients undergoing PCI in the work-up pre-TAVR. METHODS This was a multicenter study including 1,457 consecutive patients (mean age 81 ± 7 years; 41.5% women) who underwent TAVR and survived beyond 30 days. LBEs (>30 days post-TAVR) were defined according to the Valve Academic Research Consortium-2 criteria. RESULTS LBEs occurred in 116 (7.9%) patients after a median follow-up of 23 (IQR: 12-40) months. Late bleeding was minor, major, and life-threatening or disabling in 21 (18.1%), 63 (54.3%), and 32 (27.6%) patients, respectively. Periprocedural (<30 days post-TAVR) major bleeding and the combination of antiplatelet and anticoagulation therapy at discharge were independent factors associated with LBEs (P ≤ 0.02 for all). LBEs conveyed an increased mortality risk at 4-year follow-up compared with no bleeding (43.9% vs 36.0; P = 0.034). Also, LBE was identified as an independent predictor of all-cause mortality after TAVR (HR: 1.39; 95% CI: 1.05-1.83; P = 0.020). CONCLUSIONS In TAVR candidates with concomitant significant coronary artery disease requiring percutaneous treatment, LBEs after TAVR were frequent and associated with increased mortality. Combining antiplatelet and anticoagulation regimens and the occurrence of periprocedural bleeding determined an increased risk of LBEs. Preventive strategies should be pursued for preventing late bleeding after TAVR, and further studies are needed to provide more solid evidence on the most safe and effective antithrombotic regimen post-TAVR in this challenging group of patients.
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Affiliation(s)
- Marisa Avvedimento
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Erika Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, CIBERCV, Spain
| | - Luis Nombela-Franco
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico de San Carlos, Madrid, Spain
| | - Quentin Fischer
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Donaint
- Cardiology Department, Reims University Hospital, Reims, France
| | - Vicenç Serra
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gabriela Veiga
- Cardiology Department, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Victoria Vilalta
- Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alberto Alperi
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Henrique B Ribeiro
- Cardiology Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Anthony Matta
- Cardiology Department, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Antonio Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, CIBERCV, Spain
| | - Gabriela Tirado-Conte
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico de San Carlos, Madrid, Spain
| | - Marina Urena
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Metz
- Cardiology Department, Reims University Hospital, Reims, France
| | | | | | | | - Isaac Pascual
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Vidal-Cales
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Kim Hoang Trinh
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Reims, France
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.
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Vázquez DJL, López GA, Guzmán MQ, Cancelo AV, Leal FR, Rios XF, Esteban PP, Fernandez JS, Santos RC, Rodriguez JMV. Prognostic impact of coronary lesions and its revascularization in a 5-year follow-up after the TAVI procedure. Catheter Cardiovasc Interv 2023; 102:513-520. [PMID: 37471716 DOI: 10.1002/ccd.30767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). However, its prognostic significance and its management remains controversial. AIMS This study sought to determine whether the presence of CAD, its complexity, and angiography-guided percutaneous coronary intervention (PCI) are associated with outcomes after TAVI. METHODS All patients undergoing TAVI at a tertiary referral center between 2008 and 2018 were included in a prospective observational study. Baseline SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score (SS) and a residual SS after PCI were calculated. The endpoints on the 5 year follow-up were all-cause mortality and a composite of mayor cardiovascular adverse events (MACE). RESULTS In 379 patients, the presence of CAD and its complexity were not significantly associated with worse 5-year survival after TAVI, with a mortality for SS0 of 45%; for SS 1-22 of 36.5% (HR 0.77; 95% CI 0.53-1.11, p = 0.15) and for SS > 22 of 42.1% (HR 1.24; 95% CI 0.59-2.63, p = 0.57). Regarding the combined event of MACE, there were also no statistically significant differences between patients with CAD and without CAD (56.8% in patients without CAD and 54.9% in patients with CAD; HR 1.06; 95% CI 0.79-1.43, p = 0.7). Angiography-guided PCI or completeness of revascularization was not associated with different outcomes. CONCLUSIONS In the present analysis, neither the presence nor the extent of CAD, nor the degree of revascularization, was associated with a prognostic impact in patients undergoing TAVI at 5-year follow-up.
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Affiliation(s)
- Domingo José López Vázquez
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Guillermo Aldama López
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Martin Quintas Guzmán
- Department of Clinical Cardiology, Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ariana Varela Cancelo
- Department of Clinical Cardiology, Cardiology, Complexo Hospitalario Universitario Ferrol (CHUF), A Coruña, Spain
| | - Fernando Rebollal Leal
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Xacobe Flores Rios
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Pablo Piñón Esteban
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Jorge Salgado Fernandez
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Ramón Calviño Santos
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - José Manuel Vázquez Rodriguez
- Department of Interventional Cardiology, Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
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Shah KB, O’Donnell C, Mahtta D, Waldo SW, Choi C, Park K, Denktas AE, Paniagua D, Khalid U. Trends and Outcomes in Patients With Coronary Artery Disease Undergoing TAVR: Insights From VA CART. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101056. [PMID: 39132404 PMCID: PMC11307520 DOI: 10.1016/j.jscai.2023.101056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 08/13/2024]
Abstract
Background Obstructive coronary artery disease (CAD) is common in patients with severe symptomatic aortic stenosis. The management and impact of obstructive CAD in patients undergoing transcatheter aortic valve replacement (TAVR) have not been fully evaluated. We aimed to determine the patient characteristics and clinical outcomes among veterans undergoing TAVR with and without obstructive CAD and to determine temporal trends and association of pre-TAVR percutaneous coronary intervention (PCI) with clinical outcomes. Methods We identified all patients who underwent TAVR from 2012 to 2021 in the VA Health Care System. The sample population was divided into patients with and without obstructive CAD and further stratified by coronary intervention status 1 year prior to TAVR. The primary outcome was 1-year all-cause mortality, and the secondary outcome was major bleeding. Results During the study period, 759 patients underwent TAVR, and 282 (37%) had obstructive CAD. Obstructive CAD was associated with higher 1-year mortality (15.6% vs 7.1%; P < .01) after TAVR. The rate of PCI prior to TAVR increased from 2012 until 2016, after which it steadily declined such that 144 patients (51%) underwent PCI pre-TAVR during the entire study period. There was no difference in 1-year mortality (16.0% vs 15.2%; P = .89) or bleeding (16.7% vs 12.3%; P = .33) between patients who underwent or did not undergo pre-TAVR PCI. Conclusions Among veterans undergoing TAVR, the presence of obstructive CAD is associated with higher mortality though pre-TAVR coronary intervention is not associated with improved outcomes. Further studies could identify a subset of patients who may benefit from coronary revascularization prior to TAVR.
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Affiliation(s)
- Khanjan B. Shah
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
- Malcolm Randall VA Medical Center, Gainesville, Florida
| | - Colin O’Donnell
- VA Clinical Assessment, Reporting and Tracking (CART) Program, VHA Office of Quality and Patient Safety, Washington, DC
| | - Dhruv Mahtta
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Stephen W. Waldo
- VA Clinical Assessment, Reporting and Tracking (CART) Program, VHA Office of Quality and Patient Safety, Washington, DC
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- University of Colorado School of Medicine, Aurora, Colorado
| | - Calvin Choi
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
- Malcolm Randall VA Medical Center, Gainesville, Florida
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
- Malcolm Randall VA Medical Center, Gainesville, Florida
| | - Ali E. Denktas
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Section of Cardiology, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - David Paniagua
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Section of Cardiology, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Umair Khalid
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Section of Cardiology, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
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50
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Banovic M, Iung B, Wojakowski W, Van Mieghem N, Bartunek J. Asymptomatic Severe and Moderate Aortic Stenosis: Time for Appraisal of Treatment Indications. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100201. [PMID: 37745683 PMCID: PMC10512009 DOI: 10.1016/j.shj.2023.100201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 09/26/2023]
Abstract
Over the last decades, we have witnessed considerable improvements in diagnostics and risk stratification of patients with significant aortic stenosis (AS), paralleled by advances in operative and anesthetic techniques. In addition, accumulating evidence points to the potential benefit of early valve replacement in such patients prior to the onset of symptoms. In parallel, interventional randomized trials have proven the benefit of transcatheter aortic valve replacement in comparison to a surgical approach to valve replacement over a broad risk spectrum in symptomatic patients with AS. This article reviews contemporary management approaches and scrutinizes open questions regarding timing and mode of intervention in asymptomatic patients with severe AS. We also discuss the challenges surrounding the management of symptomatic patients with moderate AS as well as emerging dilemmas related to the concept of a life-long treatment strategy for patients with AS.
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Affiliation(s)
- Marko Banovic
- Belgrade Medical Faculty, University of Belgrade, Belgrade, Serbia
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Bernard Iung
- University of Paris, Paris, France
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
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