Paradis Jean-Michel, White Jonathon M, Généreux Philippe, Urena Marina, Doshi Darshan, Nazif Tamim, Hahn Rebecca, George Isaac, Khalique Omar, Harjai Kishore, Lasalle Laura, Labbé Benoit M, DeLarochellière Robert, Doyle Daniel, Dumont Éric, Mohammadi Siamak, Leon Martin B, Rodés-Cabau Josep, Kodali Susheel
Quebec Heart and Lung Institute, Quebec, Canada.
Cardiovascular Research Foundation, New-York, NY.
J Am Heart Assoc. 2017 Feb 20;6(2):e005070. doi: 10.1161/JAHA.116.005070.
The influence of coronary artery disease (CAD) on clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) is still controversial. We sought to evaluate the impact of CAD severity as measured by the SYNTAX score (SS) on patients undergoing TAVR.
A total of 377 patients who underwent TAVR in 2 high-volume centers in North America were included in our retrospective analysis. A blinded angiographic core laboratory calculated the SS on all available coronary angiograms with the use of quantitative coronary analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0); (2) low SS (SS between 1 and 22); (3) intermediate SS (SS between 23 and 32); and (4) high SS (SS ≥33). Patients who had undergone percutaneous coronary intervention within 6 months prior to TAVR were separated into 2 categories based on their residual SS (<8 and ≥8). Patients with previous coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low CABG SS and (2) high CABG SS. The primary end point was a composite of all-cause mortality, myocardial infarction, and stroke. At 30 days and 1 year, both the presence and the severity of CAD had no impact on the rate of the combined primary end point and on all-cause mortality, cardiovascular mortality, and myocardial infarction. Patients with less complete revascularization (residual SS ≥8 versus residual SS <8 and low CABG SS versus high CABG SS, had similar rates of the combined primary end point, all-cause mortality, cardiovascular mortality, MI, and stroke, at both 30 days and 1 year.
In our core laboratory-validated study, neither the severity of CAD nor completeness of revascularization after percutaneous coronary intervention or CABG were associated with clinical outcomes after TAVR, at both 30 days and 1 year.
冠状动脉疾病（CAD）对经导管主动脉瓣置换术（TAVR）后临床及超声心动图结果的影响仍存在争议。我们旨在评估通过SYNTAX评分（SS）衡量的CAD严重程度对接受TAVR患者的影响。
我们对北美2个大容量中心的377例行TAVR的患者进行了回顾性分析。一个盲法血管造影核心实验室使用定量冠状动脉分析方法，对所有可用冠状动脉造影计算SS。患者被分为4组：（1）无CAD（SS = 0）；（2）低SS（SS在1至22之间）；（3）中等SS（SS在23至32之间）；（4）高SS（SS≥33）。在TAVR前6个月内接受过经皮冠状动脉介入治疗的患者，根据其残余SS（<8和≥8）分为2类。既往有冠状动脉旁路移植术（CABG）的患者分为2组：（1）低CABG SS和（2）高CABG SS。主要终点是全因死亡、心肌梗死和卒中的复合终点。在30天和1年时，CAD的存在及严重程度对联合主要终点发生率、全因死亡率、心血管死亡率和心肌梗死均无影响。血运重建不完全的患者（残余SS≥8与残余SS<8，以及低CABG SS与高CABG SS）在30天和1年时，联合主要终点、全因死亡率、心血管死亡率、心肌梗死和卒中的发生率相似。
在我们经核心实验室验证的研究中，无论是CAD的严重程度，还是经皮冠状动脉介入治疗或CABG后的血运重建完整性，在30天和1年时均与TAVR后的临床结果无关。
