Katta Natraj, Abbott J Dawn, Kalra Ankur, Alenezi Fawaz, Goldsweig Andrew, Aronow Herbert, Velagapudi Poonam
University of Nebraska Medical Center, Omaha, NE, USA.
Brown University, Providence, RI, USA.
Heart Int. 2020 Apr 15;14(1):24-28. doi: 10.17925/HI.2020.14.1.24. eCollection 2020.
Aortic stenosis and coronary artery disease (CAD) frequently co-exist, as they share a common pathophysiology and risk factors. Due to lack of randomised controlled trials (RCTs) and exclusion of significant CAD in transcatheter aortic valve replacement (TAVR) trials, the optimal method of revascularisation of CAD in patients undergoing TAVR remains unknown. Observational studies and meta-analyses have shown varied results in outcomes for patients with CAD undergoing TAVR, and no significant difference in post-TAVR outcomes in patients who underwent revascularisation either prior to or during TAVR versus those who did not. However, some observational studies have shown that patients with lower residual SYNTAX score (rSS) post-revascularisation have better outcomes post-TAVR compared to those with higher rSS. RCTs are needed to clearly understand whether revascularisation is beneficial in these patients. Until then, management of CAD in patients undergoing TAVR must be individualised based on discussion with the heart team.
主动脉瓣狭窄和冠状动脉疾病（CAD）经常并存，因为它们具有共同的病理生理学和风险因素。由于缺乏随机对照试验（RCT）以及经导管主动脉瓣置换术（TAVR）试验中排除了严重的CAD，TAVR患者中CAD血运重建的最佳方法仍然未知。观察性研究和荟萃分析显示，接受TAVR的CAD患者的结局各不相同，并且在TAVR之前或期间接受血运重建的患者与未接受血运重建的患者在TAVR后的结局上没有显著差异。然而，一些观察性研究表明，血运重建后残余SYNTAX评分（rSS）较低的患者与rSS较高的患者相比，TAVR后的结局更好。需要进行RCT来清楚地了解血运重建对这些患者是否有益。在此之前，TAVR患者的CAD管理必须在与心脏团队讨论的基础上进行个体化。
