Back to Search Start Over

Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement.

Authors :
Faroux L
Munoz-Garcia E
Serra V
Alperi A
Nombela-Franco L
Fischer Q
Veiga G
Donaint P
Asmarats L
Vilalta V
Chamandi C
Regueiro A
Gutiérrez E
Munoz-Garcia A
Garcia Del Blanco B
Bach-Oller M
Moris C
Armijo G
Urena M
Fradejas-Sastre V
Metz D
Castillo P
Fernandez-Nofrerias E
Sabaté M
Tamargo M
Del Val D
Couture T
Rodes-Cabau J
Source :
Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2020 Feb; Vol. 13 (2), pp. e008620. Date of Electronic Publication: 2020 Jan 29.
Publication Year :
2020

Abstract

Background: Scarce data exist on coronary events following transcatheter aortic valve replacement (TAVR), and no study has determined the factors associated with poorer outcomes in this setting. This study sought to determine the clinical characteristics, outcomes, and prognostic factors of acute coronary syndrome (ACS) events following TAVR.<br />Methods: Multicenter cohort study including a total of 270 patients presenting an ACS after a median time of 12 (interquartile range, 5-17) months post-TAVR. Post-ACS death, myocardial infarction, stroke, and overall major adverse cardiovascular or cerebrovascular events were recorded.<br />Results: The ACS clinical presentation consisted of non-ST-segment-elevation myocardial infarction (STEMI) type 2 (31.9%), non-STEMI type 1 (31.5%), unstable angina (28.5%), and STEMI (8.1%). An invasive strategy was used in 163 patients (60.4%), and a percutaneous coronary intervention was performed in 97 patients (35.9%). Coronary access issues were observed in 2.5% and 2.1% of coronary angiography and percutaneous coronary intervention procedures, respectively. The in-hospital mortality rate was 10.0%, and at a median follow-up of 17 (interquartile range, 5-32) months, the rates of death, stroke, myocardial infarction, and major adverse cardiovascular or cerebrovascular events were 43.0%, 4.1%, 15.2%, and 52.6%, respectively. By multivariable analysis, revascularization at ACS time was associated with a reduction of the risk of all-cause death (hazard ratio, 0.54 [95% CI, 0.36-0.81] P =0.003), whereas STEMI increased the risk of all-cause death (hazard ratio, 2.06 [95% CI, 1.05-4.03] P =0.036) and major adverse cardiovascular or cerebrovascular events (hazard ratio, 1.97 [95% CI, 1.08-3.57] P =0.026).<br />Conclusions: ACS events in TAVR recipients exhibited specific characteristics (ACS presentation, low use of invasive procedures, coronary access issues) and were associated with a poor prognosis, with a very high in-hospital and late death rate. STEMI and the lack of coronary revascularization determined an increased risk. These results should inform future studies to improve both the prevention and management of ACS post-TAVR.

Details

Language :
English
ISSN :
1941-7632
Volume :
13
Issue :
2
Database :
MEDLINE
Journal :
Circulation. Cardiovascular interventions
Publication Type :
Academic Journal
Accession number :
31992059
Full Text :
https://doi.org/10.1161/CIRCINTERVENTIONS.119.008620