Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.).
Bern University Hospital, Inselspital, Switzerland (T.P., D.T.).
Circ Cardiovasc Interv. 2022 Dec;15(12):e012417. doi: 10.1161/CIRCINTERVENTIONS.122.012417. Epub 2022 Dec 20.
The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence.
The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years.
Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio' 0.88 [95% CI, 0.66-1.18]; =0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio' 0.97 [95% CI, 0.76-1.24]; =0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all values for interaction >0.10).
The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.
由于现有证据存在明显差异，经导管主动脉瓣置换术（TAVI）患者稳定型冠状动脉疾病（CAD）的最佳治疗方法仍不明确。
REVASC-TAVI 注册研究（经导管主动脉瓣置换术合并冠状动脉疾病患者的心肌血运重建管理）从全球 30 个中心收集了在 TAVI 术前检查中发现有显著稳定 CAD 的患者的数据。为了进行此分析，在倾向评分匹配分析中比较了完全或不完全血运重建的患者，以考虑基线混杂因素。主要和次要复合终点分别为 2 年时的全因死亡和全因死亡、卒中和心肌梗死以及心力衰竭再住院的复合终点。
在纳入的 2407 例患者中，675 对接受完全或不完全血运重建的患者进行了匹配。主要终点（21.6%比 18.2%，风险比 0.88 [95%CI，0.66-1.18]；=0.38）和次要复合终点（29.0%比 27.1%，风险比 0.97 [95%CI，0.76-1.24]；=0.83）在完全或不完全血运重建的患者之间没有差异。这些结果在不同的患者预设亚组中是一致的（年龄<75 岁或>75 岁、胸外科医生评分>4%或<4%、基线时心绞痛、糖尿病、左心室射血分数>40%或<40%、纽约心脏协会心功能分级 I/II 级或 III/IV 级、肾功能衰竭、近端 CAD、多支血管 CAD、左主干/前降支近端 CAD；所有交互作用值>0.10）。
REVASC-TAVI 注册研究的本次分析表明，在 TAVI 术前检查中发现的有显著稳定 CAD 的 TAVI 患者中，分期或与 TAVI 同时进行的完全血运重建与不完全血运重建策略相比，在降低 2 年全因死亡风险以及死亡、卒中和心肌梗死风险以及心力衰竭再住院风险方面相似，无论临床和解剖情况如何。
