Search

The clinical relevance of as well as the optimal treatment strategy for coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) are unclear. Current data are conflicting, and mainly derived from high-risk patients. We aimed to investigate the feasibility and safety of complete revascularization prior to TAVR for severe AS in low- and intermediate-risk patients. We enrolled 449 patients at low (STS score < 4%) and intermediate risk (STS score 4-8%) undergoing TAVR for severe AS and investigated the influence of recent (<3 months) and prior (>3 months) complete revascularization on clinical outcome. Primary study endpoint was all-cause mortality. Overall, 58% of patients had no or non-significant CAD; 18% had a history of complete revascularization prior to TAVR and 24% had complete revascularization shortly before TAVR. Two-year all-cause mortality was not different between patients with recent revascularization prior to TAVR and patients with no or non-significant CAD (13.7% vs. 14.2%, p = 0.905). Cox regression did not reveal an effect on all-cause mortality for recent revascularization. The present analysis reassures that percutaneous complete revascularization prior to TAVR procedures is neutral in terms of all-cause mortality in patients at low and intermediate surgical risk.

Objectives: Although substantial progress in the treatment of stable angina pectoris (sAP) has been made, little is known about the functional status and quality of life (QoL) of patients in different healthcare systems., Design and Methods: We undertook a survey using the Seattle Angina Questionnaire (SAQ) (five domains scored form 0-worst assessment to 100-best assessment) to assess symptoms, QoL (including limitation of activities), demographics, geographic distribution and individual disease data in patients with stable coronary artery disease in Austrian cardiology practices., Results: A total of 660 patients with sAP with a mean age of 69.2 years were included. SAQ scores were 67.5±24.4 for physical limitation, 65.5±26.6 for angina stability, 79.3±23.2 for angina frequency, 86.3±16.2 for treatment satisfaction and 63.7±24.2 for overall QoL. Multiple regression identified male gender, but also female gender, Eastern Austrian residence and high body mass index as predictive factors for SAQ scoring. A total of 35.6% of the patients reported at least one desirable activity that was limited through AP symptoms., Conclusions: Activity and QoL assessments are in accordance with published literature: The number and the diversity of desired activities indicate the need to focus on patient's individual activity level to improve symptom management., Competing Interests: Competing interests: EW and SB are employed by A. Menarini Pharma GmbH. TR does lecture activities for A. Menarini Pharma GmbH. RZ has relationships with the following drug companies: Novartis, Servier, AstraZeneca, Daiichi Sankyo, Amgen, Merck, Gebro, Sanofi, Boehringer, Abbott, Bayer and Menarini. These relationships include research grants, membership of scientific advisory boards, lecture activities and congress invitations. IL has relationships with drug companies including AOPOrphan Pharmaceuticals, Actelion, Bayer-Schering, AstraZeneca, Menarini, Servier, Cordis, Medtronic, GSK and Ferrer. In addition, IL, to being an investigator in trials involving these companies, relationships include consultancy service, research grants and membership of scientific advisory boards; no expert witnessing. IL had access to all study data and analyses, and was involved in the interpretation of data, writing of the paper and/or decision to submit for publication. IL serves on the editorial board of the European Heart Journal, Thrombosis and Haemostasis, and Pulmonary Circulation. IL is not sitting on a committee or organisation that may benefit from the publication of this paper. GDK has relationships with the following drug companies: AstraZeneca, Amgen, Bayer, Boehringer Ingelheim, Daiichi Sankyo MSD, Pfizer, Sanofi and Menarini. These relationships include research grants, membership of scientific advisory boards, lecture activities and congress invitations., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)