Aurigemma Cristina, Giannico Maria Benedetta, Burzotta Francesco, Romagnoli Enrico, Cangemi Stefano, Bianchini Francesco, Bruno Piergiorgio, Leone Antonio Maria, Gaspardone Achille, Crea Filippo, Trani Carlo
Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Unità Operativa Complessa Cardiologia (UOC), Ospedale Sant'Eugenio di Roma, ASL Roma 2, Rome, Italy.
Rev Esp Cardiol (Engl Ed). 2023 Mar;76(3):157-164. doi: 10.1016/j.rec.2022.05.020. Epub 2022 Jun 9.
Coronary artery disease (CAD) is found in 30%-50% of patients with severe aortic stenosis (AS) undergoing treatment. The best management of CAD in AS patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear. We investigated the clinical impact of the extent of jeopardized myocardium in patients with concomitant CAD and severe AS treated by TAVI.
Consecutive patients who underwent TAVI procedures at our hospital were identified. In the presence of CAD, the myocardium jeopardized before TAVI was graded using the British Cardiovascular Intervention Society (BCIS) jeopardy score (JS). The study population was divided in 3 groups: patients without concomitant CAD (no-CAD), patients with CAD and BCIS-JS ≤ 4 (CAD BCIS-JS ≤ 4) and patients with concomitant CAD and BCIS-JS> 4 (CAD BCIS-JS> 4). The primary study endpoint was major adverse cardiovascular and cerebrovascular events (MACCE).
A total of 403 patients entered the study: 223 no-CAD, 94 CAD BCIS-JS ≤ 4 and 86 CAD BCIS-JS> 4. At> 3 months of follow-up [range 104-3296 days], patients without CAD and CAD patients with BCIS-JS ≤ 4 had better survival free from MACCE compared with those with less extensive revascularization (BCIS-JS> 4) (P=.049). This result was driven by a significant reduction in death (P=.031). On multivariate analysis, residual BCIS-JS ≤ 4 and NYHA class III-IV independently predicted MACCE.
In patients with concomitant CAD and severe AS, the extent of jeopardized myocardium before TAVI impacts on clinical outcomes.
在接受治疗的重度主动脉瓣狭窄（AS）患者中，30%-50%存在冠状动脉疾病（CAD）。对于接受经导管主动脉瓣植入术（TAVI）的AS患者，CAD的最佳管理方案仍不明确。我们研究了TAVI治疗的合并CAD和重度AS患者中，心肌受损范围的临床影响。
确定在我院接受TAVI手术的连续患者。存在CAD时，使用英国心血管介入学会（BCIS）危险评分（JS）对TAVI前心肌受损情况进行分级。研究人群分为3组：无合并CAD患者（无CAD组）、CAD且BCIS-JS≤4患者（CAD BCIS-JS≤4组）和合并CAD且BCIS-JS>4患者（CAD BCIS-JS>4组）。主要研究终点是主要不良心血管和脑血管事件（MACCE）。
共有403例患者进入研究：223例无CAD组，94例CAD BCIS-JS≤4组，86例CAD BCIS-JS>4组。在随访>3个月时[范围104-3296天]，与血运重建范围较小（BCIS-JS>4）的患者相比，无CAD患者和CAD且BCIS-JS≤4的患者无MACCE生存情况更好（P=0.049）。这一结果是由死亡显著减少（P=0.031）驱动的。多因素分析显示，残余BCIS-JS≤4和纽约心脏协会（NYHA）III-IV级独立预测MACCE。
在合并CAD和重度AS的患者中，TAVI前心肌受损范围影响临床结局。
