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Utility of Routine Invasive Coronary Angiography Prior to Transcatheter Aortic Valve Replacement
- Source :
- Cardiovascular revascularization medicine : including molecular interventions. 26
- Publication Year :
- 2020
-
Abstract
- Background/purpose Despite the high prevalence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS), the optimal management of concomitant CAD, including revascularization before transcatheter aortic valve replacement (TAVR), remains controversial. Contemporary, real-world practice patterns have not yet been described. We aimed to characterize the burden of CAD in contemporary TAVR patients and evaluate revascularization practices at a high-volume center. Methods/materials We retrospectively analyzed all adult patients referred for TAVR at our center between January 2019 and January 2020. Presence of significant CAD and subsequent management were recorded. Presenting symptoms, use of non-invasive and invasive ischemia testing, and pre-TAVR computed tomography (CT) imaging were analyzed. Results A total of 394 patients with severe AS were referred for TAVR. Thirty-nine patients (9.9%) instead underwent surgery, of whom only 5 (1.3%) received coronary artery bypass grafting . Of the remaining 355 patients, 218 patients (61.4%) had insignificant CAD. Of the 137 patients (38.6%) with significant CAD, only 30 (8.5%) underwent percutaneous coronary intervention (PCI). Of these, less than half had anginal symptoms, a third had CAD in proximal segments, and a third underwent ischemia testing before PCI. Pre-TAVR CT accurately identified significant CAD in 28/30 patients (93.3%) who underwent PCI. Conclusions Only 1 in 25 contemporary TAVR patients had significant CAD and angina requiring intervention, calling into question the utility of routine invasive coronary angiography before TAVR. A Heart Team approach integrating anginal symptoms, ischemia testing and possibly pre-TAVR CT is needed to guide the need, timing, and strategy of revascularization.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Ischemia
Coronary Artery Disease
030204 cardiovascular system & hematology
Revascularization
Coronary Angiography
Coronary artery disease
Angina
Transcatheter Aortic Valve Replacement
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Valve replacement
Risk Factors
Internal medicine
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Retrospective Studies
business.industry
Percutaneous coronary intervention
General Medicine
Aortic Valve Stenosis
medicine.disease
Stenosis
Treatment Outcome
Aortic Valve
Conventional PCI
Cardiology
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 18780938
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Cardiovascular revascularization medicine : including molecular interventions
- Accession number :
- edsair.doi.dedup.....bb197e7286a5b73ef9a9b6559520ee01