Division of Cardiology, Department of Medicine, University of Verona, Italy; Oxford Heart Centre, Oxford University Hospitals, Oxford, UK.
Division of Cardiology, Department of Medicine, University of Verona, Italy.
Cardiovasc Revasc Med. 2022 Sep;42:47-52. doi: 10.1016/j.carrev.2022.02.024. Epub 2022 Feb 28.
Whether incomplete functional revascularization has an impact on the clinical outcome of patients treated with transcatheter aortic valve implantation (TAVI) is still unknown. We aim to assess the prognostic value of residual functional SYNTAX score (rFSS) in a cohort of patients undergoing TAVI.
One-hundred-twenty-four patients (229 lesions) with severe aortic stenosis and coronary artery disease (CAD) underwent fractional flow reserve (FFR)-guided revascularization. The primary endpoint of the study was the composite of cardiac death, myocardial infarction, and revascularization at the last available follow-up after TAVI. Median SYNTAX score (SS) and Functional SYNTAX score (FSS) at baseline were 7 (range 5-12) and 0 (range 0-7) respectively. After revascularization or deferral according to FFR, residual SS (rSS) and rFSS were 5 (range 0-8) and 0 (range 0-0) respectively. Angiographic incomplete revascularization (rSS > 0) was not associated with the primary endpoint (HR 1.2; 95% CI 0.4-3.9; p = 0.69), whereas functional incomplete revascularization (rFSS>0) was associated with worse event-free survival at follow up after adjusting for clinical confounders (HR 3.7; 95% CI 1.0-13.7; p = 0.04).
Incomplete functional revascularization is associated with adverse clinical outcomes after TAVI. Residual functional SYNTAX score may be regarded as a treatment goal for patients with CAD undergoing TAVI. Further studies are warranted to confirm our hypothesis.
经导管主动脉瓣置换术（TAVI）治疗后，不完全功能性血运重建是否会影响患者的临床结局尚不清楚。我们旨在评估接受 TAVI 治疗的患者中残余功能性 SYNTAX 评分（rFSS）的预后价值。
124 例严重主动脉瓣狭窄合并冠状动脉疾病（CAD）患者（229 处病变）接受了血流储备分数（FFR）指导的血运重建。研究的主要终点是 TAVI 后最后一次可获得随访时的心脏死亡、心肌梗死和血运重建的复合终点。基线时的中位数 SYNTAX 评分（SS）和功能性 SYNTAX 评分（FSS）分别为 7（范围 5-12）和 0（范围 0-7）。根据 FFR 进行血运重建或延迟血运重建后，残余 SS（rSS）和 rFSS 分别为 5（范围 0-8）和 0（范围 0-0）。血管造影不完全血运重建（rSS>0）与主要终点无关（HR 1.2；95%CI 0.4-3.9；p=0.69），而功能性不完全血运重建（rFSS>0）在调整临床混杂因素后与随访时无事件生存不良相关（HR 3.7；95%CI 1.0-13.7；p=0.04）。
不完全功能性血运重建与 TAVI 后不良临床结局相关。残余功能性 SYNTAX 评分可作为 CAD 患者接受 TAVI 治疗的目标。需要进一步研究来证实我们的假设。
