Impact of Coronary Artery Disease on Postoperative Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR): Is Preoperative Coronary Revascularization Necessary?

BACKGROUND

There remains much controversy on impact of preoperative coronary artery disease (CAD) and necessity of preoperative coronary revascularization on postoperative outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).

METHODS

Data were collected retrospectively for 364 consecutive patients undergoing TAVR at Newark Beth Israel Medical Center, New Jersey, from May 15, 2012 to September 17, 2015. Preoperative CAD burden was calculated by three different measures of CAD: SYNTAX score, Duke Myocardial Jeopardy score (DMJS), and number of diseased coronary arteries. A composite endpoint of allcause mortality, major adverse cardiac and cerebrovascular event, and postoperative revascularization procedures was used as the primary endpoint in the survival analysis. Association of measures of CAD to composite endpoint were evaluated by multivariate Cox regression model for the first measure and log-rank test for the last two measures, respectively. Kaplan-Meier survival curves were derived by all three CAD measures. Thirty-day and 1-year composite endpoint rates were compared among strata defined by tertiles of SYNTAX score, DMJS, and number of diseased coronary vessels.

RESULTS

A subset of 238 patients who met all inclusion criteria were eligible for final analysis. There was no significant association between the composite endpoint and SYNTAX score (hazard ratio, 0.77; 95% confidence interval, 0.47-1.23; P=.27); CAD by DMJS (P=.24), or number of diseased coronary arteries (P=.60). Independent predictors of poor postoperative outcomes included male gender, STS score, and frailty. There was no statistically significant association between preoperative CAD measures and 30-day or 1-year composite endpoint rates.

CONCLUSION

In patients with asymptomatic CAD undergoing TAVR for severe symptomatic aortic stenosis, preoperative coronary revascularization may not be necessary.