Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
BMC Cardiovasc Disord. 2021 Nov 30;21(1):568. doi: 10.1186/s12872-021-02374-y.
The aim of the study was to analyze the impact of concomitant coronary artery disease (CAD) assessed by the SYNTAX score (SS) and periprocedural percutaneous coronary intervention (PCI) on outcomes after transcatheter aortic valve replacement (TAVR).
Due to controversial data regarding the effect of CAD on outcomes after TAVR, proper revascularization strategies remain a matter of debate.
553 patients with severe aortic stenosis undergoing TAVR were included in this study. SS was calculated for each patient at baseline and after PCI. Primary outcome was one-year all-cause mortality.
60.2% of patients (N = 333) exhibited CAD with a mean SS of 10.8 ± 8.8. Of those, 120 patients (36.0%) received periprocedural PCI. In the treatment group, mean SS was decreased from 14.9 ± 9.1 to 6.3 ± 6.7. Patients with concomitant CAD suffered more frequently from myocardial infarction (MI) post TAVR compared to those without CAD (2.1% vs. 0.0%; P < 0.01). In the CAD cohort, MI rates were comparable between patients with and without PCI (2.2% vs. 2.5%; P = 0.71). Regarding SS, patients with a residual SS < 8 showed significant lower rates of one-year mortality (9.0% vs. 18.2%; P = 0.016) and MACCE (16.5% vs. 32.2%; P = 0.001). Besides left bundle brunch, predictors for an increased one-year mortality were a residual SS ≥ 8 in the CAD group (OR = 3.17; P = 0.011) and a EuroSCORE ≥ 4% in the entire study population (OR = 2.18; P = 0.017).
Our results suggest that a residual SS-guided revascularization strategy may improve prognosis after TAVR in patients with concomitant CAD. PCI aiming for a residual SS < 8 was associated with improved one-year clinical outcomes.
本研究旨在分析通过 SYNTAX 评分（SS）评估的同时存在的冠状动脉疾病（CAD）以及经皮冠状动脉介入治疗（PCI）对经导管主动脉瓣置换术（TAVR）后结局的影响。
由于 CAD 对 TAVR 后结局影响的数据存在争议，适当的血运重建策略仍然是一个争论的问题。
本研究纳入了 553 例接受 TAVR 的严重主动脉瓣狭窄患者。在基线和 PCI 后为每位患者计算 SS。主要终点为一年全因死亡率。
60.2%的患者（N=333）存在 CAD，平均 SS 为 10.8±8.8。其中，120 例患者（36.0%）接受了 PCI。在治疗组中，平均 SS 从 14.9±9.1 降至 6.3±6.7。与无 CAD 的患者相比，同时存在 CAD 的患者 TAVR 后更常发生心肌梗死（MI）（2.1% vs. 0.0%；P<0.01）。在 CAD 队列中，有和无 PCI 的患者的 MI 发生率无差异（2.2% vs. 2.5%；P=0.71）。关于 SS，残余 SS<8 的患者一年死亡率（9.0% vs. 18.2%；P=0.016）和 MACCE（16.5% vs. 32.2%；P=0.001）显著降低。除左束支阻滞外，CAD 组中残余 SS≥8（OR=3.17；P=0.011）和整个研究人群中 EuroSCORE≥4%（OR=2.18；P=0.017）是一年死亡率增加的预测因素。
我们的结果表明，残余 SS 指导的血运重建策略可能改善同时存在 CAD 的 TAVR 患者的预后。旨在达到残余 SS<8 的 PCI 与改善一年临床结局相关。
