Guedeney Paul, Tchétché Didier, Petronio Anna Sonia, Mehilli Julinda, Sartori Samantha, Lefèvre Thierry, Presbitero Patrizia, Capranzano Piera, Iadanza Alessandro, Sardella Gennaro, Van Mieghem Nicolas M, Sorrentino Sabato, Claessen Bimmer E P M, Chandrasekhar Jaya, Vogel Birgit, Kalkman Deborah N, Meliga Emanuele, Dumonteil Nicolas, Fraccaro Chiara, Trabattoni Daniela, Mikhail Ghada, Ferrer-Grazia Maria-Cruz, Naber Christoph, Kievit Peter, Baber Usman, Sharma Samin, Morice Marie-Claude, Chieffo Alaide, Mehran Roxana
Icahn School of Medicine at Mount Sinai, New York, New York.
Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
Catheter Cardiovasc Interv. 2019 May 1;93(6):1124-1131. doi: 10.1002/ccd.28012. Epub 2018 Dec 4.
To evaluate the impact of coronary artery disease (CAD) with or without recent (≤ 30 days) percutaneous coronary intervention (PCI) in women undergoing transcatheter aortic valve replacement (TAVR).
Although women display a specific risk-profile for both PCI and TAVR, the impact of CAD and PCI in the setting of TAVR in women is unclear.
The multinational Women's International Transcatheter Aortic Valve implantation registry enrolled consecutive female patients undergoing contemporary TAVR in 19 centers between 2013 and 2015. Patients with available coronary angiography or CT scan in the pre-operative assessment of TAVR were categorized as without CAD, with CAD but no recent PCI and CAD and recent PCI (≤30 days). All events were adjudicated according to the VARC-2 criteria.
A total of 787 patients were included in this analysis, among whom 459 (58.3%) had no CAD, 247 (31.4%) had CAD without recent PCI and 81 (10.3%) underwent recent PCI (≤ 30 days before TAVR). After multivariable adjustment, both groups of CAD patients, without and with recent PCI, presented with higher risk of death, myocardial infarction or stroke, compared with patients without CAD ( HR 1.56, 95%CI 1.03-2.39, P = 0.038 and HR 1.96, 95% CI 1.1-3.5, P = .021, respectively). Patients with recent PCI had increased risk of all-cause death ( HR 1.89, 95% CI 1.0-3.5, P = 0.04) and stroke ( HR 3.7, 95% CI 1.0-13.5, P = 0.046) compared with patients without CAD.
The presence of CAD in women undergoing TAVR, with or without recent PCI, was associated with long-term poorer outcomes.
评估接受经导管主动脉瓣置换术（TAVR）的女性患者中，有无近期（≤30天）经皮冠状动脉介入治疗（PCI）的冠状动脉疾病（CAD）的影响。
尽管女性在PCI和TAVR方面均表现出特定的风险特征，但CAD和PCI在女性TAVR背景下的影响尚不清楚。
多国女性国际经导管主动脉瓣植入注册研究纳入了2013年至2015年间在19个中心连续接受当代TAVR的女性患者。在TAVR术前评估中进行了冠状动脉造影或CT扫描的患者被分类为无CAD、有CAD但近期未行PCI以及有CAD且近期行PCI（≤30天）。所有事件均根据VARC-2标准进行判定。
本分析共纳入787例患者，其中459例（58.3%）无CAD，247例（31.4%）有CAD但近期未行PCI，81例（10.3%）近期行PCI（TAVR前≤30天）。多变量调整后，与无CAD的患者相比，两组CAD患者，无论近期是否行PCI，死亡、心肌梗死或中风风险均更高（HR分别为1.56，95%CI 1.03 - 2.39，P = 0.038；HR 1.96，95%CI 1.1 - 3.5，P = 0.021）。与无CAD的患者相比，近期行PCI的患者全因死亡风险增加（HR 1.89，95%CI 1.0 - 3.5，P = 0.04），中风风险增加（HR 3.7，95%CI 1.0 - 13.5，P = 0.046）。
接受TAVR的女性患者中，无论有无近期PCI，CAD的存在均与长期较差的预后相关。
